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30 May 2022 : Case report  USA

[In Press] Non Ischemic Cardiomyopathy in a 54-Year-Old Khat Consuming Yemeni Male Presenting with Worsening Exertional Dyspnea, T Wave Inversions in V5-V6 and Normal Coronary Artery Angiography

Unknown etiology, Challenging differential diagnosis

Emmanuel U. Emeasoba1ABCDEF, Sanchit V. Kundal1ABCDEF, Cece Emeka Ibeson1DEF, Ifeanyi Nwosu1DEF, Amit Gulati1DEF, Benjamin Weindorf1DEF, Amin Hossam1F, Vijay Shetty1DE

DOI: 10.12659/AJCR.935601

Am J Case Rep In Press; DOI: 10.12659/AJCR.935601  

Available online: 2022-05-30, In Press, Corrected Proof

Publication in the "In-Press" formula aims at speeding up the public availability of the pending manuscript while waiting for the final publication. The assigned DOI number is active and citable. The availability of the article in the Medline, PubMed and PMC databases as well as Web of Science will be obtained after the final publication according to the journal schedule

Abstract

BACKGROUND
Khat (Catha edulis) is a plant cultivated in Ethiopia, East African, and the Arabian Peninsula. Long-term khat consumption has been associated with increased rates of periodontal diseases, esophagitis, psychosis, and cardiovascular issues such as cerebrovascular accidents, myocardial ischemia, and ischemic cardiomyopathy (CM). We report a case of khat-induced non-ischemic CM in a patient with no other known cardiovascular risk factors and highlight a cardiovascular effect of chronic khat consumption.
CASE REPORT
A 54-year-old Yemeni man with no known medical history but a chronic khat chewer presented with worsening exertional dyspnea for 6 months and associated pedal edema. Laboratory studies were remarkable for elevated B-type natriuretic peptide (BNP). Electrocardiogram (EKG) revealed normal sinus rhythm with non-specific T wave inversions (TWI) in V5-V6. A computed tomography (CT) scan of the chest showed bilateral pleural effusions with interlobular septal thickening. Transthoracic echocardiogram (TTE) showed a left ventricular ejection fraction (LVEF) of 16-20% and global CM. Coronary angiography revealed normal coronaries.
CONCLUSIONS
Chronic khat consumption is being recognized as a dangerous habit with serious health consequences and its association with ischemic CM is well documented. The findings of ischemic cardiac changes of acute coronary syndrome in a patient with normal coronary arteries raises the possibility that khat toxicity was associated with coronary artery spasm due to its amphetamine-like stimulatory effects. Although further research is required to substantiate this relationship, it is imperative that khat consumption be considered a risk factor when assessing for CM.

Keywords: Cardiomyopathies; Catha; Heart Failure, Systolic

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923