The psychostimulating herbal drug Khat (Catha edulis Forsk.) is cultivated and used as a recreational drug in East Africa and the Arabian Peninsula. The chewing habit has now spread to ethnic communities in the rest of the world. Historically, Khat is used at funerals, marriages and business deals.
We report a case of a 28-year-old African male who was admitted to the emergency department of our hospital with chest pain, somnolence and apparent aphasia, which developed after chewing Khat. The patient had consumed two strings with multiple leaves to celebrate the Festival of Breaking the Fast (Eid ul- Fitr). On the ECG (panel A) clear signs of an inferoposterolateral myocardial infarction were observed. Primary cardiac catheterisation revealed that this was due to a thrombus in the proximal right coronary artery and an occluded posterolateral branch (panel B). Therefore thrombosuction and primary percutaneous intervention were performed, followed by administration of abciximab.
Figure 1.
Panel A: ECG with clear signs of an inferoposterolateral myocardial infarction.
Figure 1.
Panel B: Coronary angiogram of RCA with proximal thrombus (proximal arrow) and distal signs of an occluded posterolateral branch (distal arrow). Panel C and D: MRI angiogram (coronal and transversal image) of absent left middle cerebral artery due to thrombotic occlusion.
Because of the ongoing somnolence and aphasia an MRI angiogram was performed, which showed cerebral infarction due to an occluded left middle cerebral artery (panel C and D).
The patient recovered well from his myocardial infarction. On echocardiography only mild hypokinesia of the posterolateral wall was observed. The neurological recovery was incomplete. At follow-up the patient had persistent signs of aphasia, for which an extensive neurological recovery programme was needed.
Previous reports have suggested that increased myocardial oxygen demand in combination with coronary vasoconstriction could be a major contributing factor to the cardiovascular complications associated with Khat use. Our case suggests that increased thrombogenecity could be a key factor.
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