Street Drug, an Inotrope in Heart Failure?

Methamphetamine is one of the most commonly abused illegal stimulants and causes the release of dopamine, norepinephrine and serotonin. These neurotransmitters trigger vasospasm, causing persistent tachycardia, hypertension, and direct myocardial toxicity. Moderate usage of methamphetamine can increase cardiac output and myocardial contractility. However, larger doses can cause depression of the myocardium. We recently encountered a young man with chronic methamphetamine use who presented with decompensated heart failure after acute cessation of methamphetamine use and his condition improved with low dose inotropic support.