5th International Conference on Heart and Cardiovascular Diseases

Sajja Sharma earned her MBBS from the Nepalese Army Institute of Health Sciences, Nepal. She is currently working toward a residency career in the United States, with internal medicine as her intended specialty.

Background: Mixed amphetamine salts are prescribed for ADHD, but they are also misused often. Severe cardiotoxicity is uncommon, and acute biventricular cardiomyopathy with respiratory failure after massive extended-release overdose is rarely described.

Objectives: To describe the clinical presentation, management, and recovery of severe biventricular cardiomyopathy following an intentional extended-release Adderall (amphetamine-dextroamphetamine) overdose, and to highlight the potential for complete myocardial recovery with appropriate supportive care.

Methodology: Single-patient case report. A 26-year-old man with depression presented about 33 hours after ingesting roughly 500 mg of extended-release mixed amphetamine salts (25 × 20 mg) with lorazepam. Assessment included ECG, laboratory and toxicology testing, chest radiography, CT angiography, and serial transthoracic echocardiography, with follow-up at two months.

Key Results/Findings: He presented with chest pain, tachycardia, hypotension, hypoxemia, lactic acidosis, rhabdomyolysis, and markedly elevated troponin and BNP. ECG revelaed diffuse ST-segment depressions, and imaging suggestive of pulmonary edema and acute lung injury without pulmonary embolism. Echocardiography revealed severe global biventricular dysfunction (LVEF <20%).He had acute hypoxemic respiratory failure required intubation eventually improved with supportive intensive care, diuresis, and heart failure therapy. He declined coronary angiography and left against medical advice, so ischemic causes and myocarditis were not definitively excluded. At two months, echocardiography showed complete biventricular recovery (LVEF 55–60%).

Conclusion: Massive extended-release amphetamine overdose can cause profound but reversible biventricular cardiomyopathy, even with delayed presentation. Clinicians should consider stimulant cardiotoxicity in young patients with chest pain, pulmonary edema, and new severe ventricular dysfunction. Early echocardiography, supportive care, psychiatric evaluation, and close follow-up are essential.