Acute onset heart failure due to reverse type Takotsubo cardiomyopathy caused by a single dose of 4-Fluoroamphetamine in a healthy young individual

• Published in: Toxicology reports 2020-01, Vol.7, p.1629-1633
• Main Authors: van der Pas, R.S.D., Gresnigt, F.M.J., Wansink, L., Franssen, E.J.F., Riezebos, R.K.
• Format: Article
• Language: English
• Subjects: 4-Fluoroamphetamine; Adverse events; Cardiogenic shock; Regular; Reverse type Takotsubo cardiomyopathy
• ISSN: 2214-7500; 2214-7500
• DOI: 10.1016/j.toxrep.2020.12.003

[Display omitted] •4-Fluoroamphetamine (4-FA) is a popular new psychoactive stimulant that is used for recreational purposes.•A single dose of 4-FA can lead to reverse type Takotsubo cardiomyopathy with cardiogenic shock.•4-FA use can cause a very sudden onset of severe symptoms.•Due to mild and late onset of effect, 4-FA users have the tendency to take an extra dose.•Phosphodiesterase-3-inhibitors are effective for amphetamine type stimulant induced Takotsubo cardiomyopathy. 4-fluoroamphetamine (4-FA) is a novel psychoactive stimulant with a global presence on the drug market. Despite the popularity of 4-FA, data on severe adverse effects are scarce. We present a case of laboratory confirmed 4-FA mono intoxication causing acute heart failure due to a reverse type Takotsubo cardiomyopathy. A 20-year-old male with no previous medical history and no reported previous drug use, presented to the emergency department (ED) with complaints of headache, nausea and vomiting, approximately 4.5 h after the ingestion of a single 4-FA pill. After 30 min his condition deteriorated with severe hypertension, tachycardia and respiratory failure. Echocardiography showed a reverse type Takotsubo cardiomyopathy. The patient was successfully treated with mechanical ventilation, a phosphodiesterase-3-inhibitor (PDE3-inhibitor) and diuretics. Three months after hospital admission, the patient was free of complaints and his left ventricular function fully recovered. Recreational use of 4-FA may result in acute onset life-threatening cardiorespiratory toxicity, preceded by severe hypertension, even in drug-naïve patients without any medical history. Emergency physicians and cardiologists should be cautious not to underestimate life-threatening 4-FA complications.