Emergency. 2017; 5 (1): e47

CA S E RE P O RT

Recurrent Syncope following Substance Abuse; a Case Re-
port
Forod Salehi1, Mohammad Mehdi Hassanzadeh Taheri2, HamidReza Riasi3, Omid Mehrpour4,5∗

1. Department of Pediatric, Birjand University of Medical Sciences, Birjand, Iran.

2. Department of Anatomical Sciences, Faculty of Medicine, Birjand University of Medical Sciences, Birjand, Iran.

3. Neurology Department, Birjand University of Medical sciences, Birjand, Iran.

4. Atherosclerosis and Coronary Artery Research Center, Birjand University of Medical Sciences, Birjand, Iran.

5. Medical Toxicology and Drug Abuse Research Center, Birjand University of Medical Sciences, Birjand, Iran.

Received: May 2016; Accepted: July 2016; Published online: 14 January 2017

Abstract: Drug abuse is considered as the most common poisoning in the world. Stimulants agent especially am-
phetamines and methamphetamines are among important abused substances. Different types of neurologic,
psychiatric, respiratory, gastrointestinal, and cardiogenic complications have been reported to be related to
methamphetamine consumption. Some of these substances could cause dysrhythmias which is the most preva-
lent etiology of cardiogenic syncope. Ecstasy, as one of the most commonly abused drugs, is known as a cause
of cardiac dysrhythmias. Here we report a young boy who was admitted into the emergency department follow-
ing three syncope attacks. All cardiac and neurologic assessments were normal; and finally ecstasy abuse was
detected as the main etiology of syncopes.

Keywords: Substance-related disorders; syncope; amphetamine; N-Methyl-3,4-methylenedioxyamphetamine; case report

© Copyright (2017) Shahid Beheshti University of Medical Sciences

Cite this article as: Salehi F, Hassanzadeh Taheri M, Riasi H, Mehrpour O. Recurrent Syncope following Substance Abuse; a Case Report.

Emergency. 2017; 5 (1): e47.

1. Introduction

Drug abuse is considered as the most common poisoning

in the world and about 2 to 5 million of such poisoning oc-

cur annually in the united states (1). Stimulants agent es-

pecially amphetamines and methamphetamines are among

important abused substances (2). Different types of neu-

rologic, psychiatric, respiratory, gastrointestinal, and car-

diogenic complications have been reported to be related to

methamphetamine consumption (3-7). Some of these sub-

stances could cause dysrhythmias which is the most preva-

lent etiology of cardiogenic syncope (8). To emphasize the

importance of this topic, here we report a case of recurrent

syncope following amphetamine abuse.

∗Corresponding Author: Omid Mehrpour; Medical Toxicology and Drug
Abuse Research Center, Birjand University of Medical Sciences, Moallem Av-
enue, Birjand, Iran. Tel: +985632381270; Email: omehrpour@yahoo.com.au

2. Case presentation:

An 18-year-old boy was admitted to the emergency depart-

ment of Markaze–Tebi–Koodakan Hospital, Tehran, Iran with

chief complaint of sudden weakness, transient loss of con-

sciousness and falling down at home. A meticulous history

of the patient revealed 2 similar attacks in last 3 months. Fur-

ther evaluations in previous attacks including brain imaging,

cardiac stress test were all negative and genetic testing re-

vealed no evidence of channelopathies. There was no history

of head trauma, cardiac disease or regular medication use.

The patient denied any substance abuse and family history

revealed no sudden cardiac death. The patient’s vital signs

on admission were stable, neurological and cardiac exami-

nations were normal. His Glasgow coma score (GCS) was

15/15, pupils responded normally to light, deep tendon re-

flex (DTR) and cranial nerves examinations did not revealed

any abnormality. Electrolytes, blood sugar level, and thy-

roid function tests were performed and all were reported in

normal range. The patient’s electrocardiogram (ECG) on ar-

rival was normal. Echocardiographic evaluation showed no

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F. Salehi et al. 2

Figure 1: 24 hours cardiac holter monitoring. a uniform, sustained

ventricular tachycardia.

structural heart disease. Brain magnetic resonance imaging

(MRI) and electroencephalography (EEG) were normal and

the tilt test result was negative. Twenty-four hour cardiac

holter monitoring was performed in which a uniform, sus-

tained ventricular tachycardia (VT) was revealed (Figure 1).

Psychiatric consultation was carried out due to poor family

support and chaotic family interactions. Psychiatric consul-

tation revealed that the patient had two previous suicide at-

tempts and history of ecstasy abuse. Based on history, he

had used ecstasy a night before, thereby resulting in syn-

cope attacks. An evaluation of serum toxins level revealed a

methamphetamine serum level of 12 mg/dl. The patient was

discharged with a diagnosis of syncope caused by VT due to

methamphetamine abuse. Psychiatric follow-up was advised

for 6 months. During this period, ecstasy usage was discon-

tinued and he did not experience any episode of syncope at-

tacks.

3. Discussion:

Although, intoxication and their complications are usually

associated with overdose consumption of abuse drugs, but

the use of actual dose of amphetamine may lead to car-

diovascular events (9). Palpitation, premature ventricu-

lar and supraventricular contraction, accelerated atrioven-

tricular conduction, atrioventricular block, bundle branch

block, supraventricular tachycardia, ventricular tachycardia

and fibrillation are among the most prevalent cardiogenic

complications (10). In a study by Fabrizio et al. it was

shown that methylenedioymethamphetamine (MDMA) in-

duces arrhythmia through the release of serotonin and cat-

echolamine (especially noradrenaline), which are responsi-

ble for most severe accidents in the cardiovascular system

(4). Elevated catecholamine level causes tachycardia and hy-

pertension that lead to increased oxygen demand and va-

sospasm. Myocardial ischemia occurs in response to de-

creasing oxygen supply and increasing oxygen demand in the

myocardium that leads to increasing the potential risk of car-

diac arrhythmia (11). Zhuo et al. demonstrated the mecha-

nism of reduction of connexin 43 and N-cadherin (myocar-

dial gap junction proteins) in the pathophysiology of car-

diovascular arrhythmia due to MDMA exposure. MDMA re-

duces both connex in 43 and N-cadherin. These forms of

proteins are multiprotein complexes that could allow the as-

semblage of both gap and fascia adherens junctions. Loss

or decreased gap junction-proteins may disrupt cardiac im-

pulse propagation and result in ventricular arrhythmia (12).

After cannabis, methamphetamines and their compounds

have become the most widely abused illicit drugs all over

the world (8, 13). Ecstasy is an easily available drug and

used mainly by young individuals in parties. This case study

presents a young man with recurrent syncope further diag-

nosed as ecstasy abuse as the main cause. In syncope with

unknown etiology, history of the patient must be suspected

and accurately examined.

4. Appendix

4.1. Acknowledgements

The author thanks Dr. Toba Kazemi, for editing this

manuscript.

4.2. Author’s contribution

F.S managed the patient. H.M and M HT followed the patient

and wrote the draft. OM completed, revised and approved

the article.

4.3. Conflict of interest

The authors declare that there is no conflict of interest.

4.4. Funding

None.

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	Introduction
	Case presentation:
	Discussion: 
	Appendix
	References