Siena, Italy - Italian doctors have reported the case of a man who seems to have recovered somewhat from cardiomyopathy associated with long-term cocaine use [1]. The patient, aged 31, was initially a candidate for heart transplantation but is now stable with virtually no symptoms and an NYHA class of 1-2, lead author Dr Valerio Zaca (University of Siena, Italy) told heartwire.

Zaca and colleagues describe their experience in the May 5, 2005 issue of the Lancet.

Zaca said he was not surprised by the case, because there have been similar reports in the literature from the 1980s. "The most important finding of this case is that regression of cardiomyopathy induced by long-term cocaine use is possible," he said.

The patient originally presented to Siena General Hospital in August 2005 with fatigue, dyspnea, and chest pain, admitting long-term cocaine misuse. Transthoracic echocardiography showed left-ventricular dilatation, with an end-diastolic diameter of 80 mm, diffuse hypokinesia, severe impairment of contractile function, and an ejection fraction of 20%. His NYHA class was 3-4, said Zaca.

Treatment was undertaken, with the patient being discharged on carvedilol, ramipril, furosemide, potassium canrenoate, and warfarin; he also received drug-abuse counseling and has tested negative in a series of unscheduled urine toxicology screens. In September of last year, his end-diastolic diameter had fallen to 57 mm, the diffuse hypokinesia was far less marked, and the EF had risen to 50%.

"The patient was so scared at the beginning," Zaca told heartwire. "We were talking about heart transplantation, so he was really compliant with therapy and a pleasure to work with."

He is continuing to take beta blockers, ACE inhibitors, warfarin, and diuretics, and had another follow-up appointment last week, the doctor noted. "We did not observe any further improvement. His echo is stable, and he has mild symptoms, such as fatigue, but he said he was content and is doing some sports."