Consent This article has been accepted for publication as a letter rather than a case report due to an inability to contact the patient to gain written or verbal consent for publication. The letter has been anonymised, and the author affiliations are available by request to the Editor-in-Chief. The manuscript has undergone extensive review by JICS editors and the Editor-in-Chief of another medical journal in order to ensure that the principles behind its publication strictly adhere to the guidance of the Committee on Publication Ethics. Caldicott Guardian approval for its publication has been given by the Executive Medical Director of the Trust in which the patient was treated. All reviewers believe that the message being imparted justifies its publication albeit in an anonymised form.

The use of novel synthetic recreational drugs has increased significantly over the last decade.1 We wish to highlight a case of acute reversible cardiomyopathy following the intravenous use of 4-methylmethcathinone (MCAT), a synthetic cathinone and class B drug of misuse with a side effect profile comparable to amphetamines. Acute cardiomyopathy following amphetamine abuse is well documented, but it is not currently described on the National Poisons Centre Database, Toxbase™ as a consequence of MCAT abuse.

Due to an inability to obtain consent from the patient, this letter highlights only the key clinical information needed to emphasise the learning points and omits any details that could lead to the identification of the patient.

A patient presented to our hospital critically unwell after injecting MCAT intravenously. They were intubated due to a persistent drop in Glasgow Coma Scale. Initial investigations demonstrated a severe mixed acidosis (pH < 7.0), acute kidney injury and profound hypotension with bradycardia which proved unresponsive to fluid loading and multiple boluses of adrenoreceptor agonists and anticholinergic agents. The patient eventually responded to a large bolus of epinephrine (500 µm) and subsequently required an epinephrine infusion to maintain an adequate blood pressure. A bedside echocardiogram using FICE standards revealed a globally dilated left ventricle with very poor contractility. Over the next 12 h, the patient continued to require very high dose inotropic support for cardiogenic shock. Spontaneous and rapid recovery were subsequently observed over a 2-h period during which inotropic support was weaned and, ultimately discontinued; the patient was successfully weaned from artificial ventilation and the trachea was extubated. Repeat echocardiogram demonstrated significant improvement in left ventricular dilatation and contractility that continued to improve on subsequent scans over the next 48 h. The patient was discharged soon after, and we are unaware of any significant sequelae post discharge.

An extensive literature search of this topic found only one case describing a direct link between synthetic cathinones and acute cardiomyopathy although there are case reports attributing deaths to cathinone abuse. Kesha et al.2 described a case of a young male who deteriorated with ventricular tachycardia and hyperthermia after intravenous cathinone use, and Maskell et al.3 discussed four deaths linked to the use of cathinones. In 2013, acute cardiomyopathy following cathinone injection was reported by Sivagnanam et al.4 in a 27-year-old male initially presenting with agitation but then suffering significant cardiovascular deterioration with echocardiogram findings of dilated cardiomyopathy and ejection fraction of 15–20%. This had reversed at follow-up 20 weeks later. Additionally, cardiac MRI proven myocarditis was reported by Nicholson et al.5 in a young male presenting with chest pain, ST elevation on electrocardiography and raised troponins after ingesting oral mephedrone.

This case demonstrates the potential consequences of one of the more modern synthetic stimulants. Cathinones are now being taken by injection as well as using the oral and insufflation routes; we believe an awareness of potential acute reversible cardiomyopathy is important, as the management focus may be changed accordingly. Our experience also highlights the value of having core bedside echocardiography skills available 24-h a day, irrespective of the operator’s background.

Declaration of Conflicting Interests The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding The author received no financial support for the research, authorship, and/or publication of this article.