A case of transient right ventricular failure secondary to severe pulmonary hypertension in setting of methamphetamine use

Methamphetamine has been documented to be associated with pulmonary hypertension. Past studies have shown the association of methamphetamine abuse with pulmonary hypertension; however, cases of isolated acute to subacute right heart failure secondary to methamphetamine use have not been documented. Acute to subacute right heart failure, secondary to methamphetamine use itself represents a diagnostic challenge as there is no specific protocol in place for evaluation for pulmonary hypertension secondary to methamphetamine use and high degree of suspicion is needed to differentiate it from other cardio-pulmonary conditions. Echocardiographic findings of increased right ventricular systolic pressure along with morphological findings suggesting cardiac remodeling in the setting of methamphetamine use is highly suspicious of acute to subacute right heart failure. Early recognition and management, along with long-term abstinence from methamphetamine use is critical to prevent chronic effects on myocardium and to prevent further cardiac remodeling. Although dedicated cardiothoracic imaging and cardiac catheterization can be beneficial; neither of these modalities are needed to establish the diagnosis and to initiate primary interventions. Computed tomography (CT) scan however would be beneficial in excluding other causes of pulmonary hypertension, such as primary pulmonary conditions and pulmonary embolism.