APCU25MPA6 Beyond cardiomyopathy: methamphetamine-induced severe aortic regurgitation

Background Methamphetamine is a potent central nervous system stimulant widely known for its cardiotoxicity, including arrhythmias and dilated cardiomyopathy. However, severe valvular involvement, particularly aortic regurgitation remains rarely reported. This case highlights an unusual presentation of methamphetamine-induced severe AR and mitral valve degeneration necessitating double valve replacement in a young adult.Case Presentation A 20-year-old male with a one-year history of methamphetamine abuse presented with progressive heart failure symptoms.Transthoracic echocardiography showed a severely reduced left ventricular ejection fraction 30%, prolapse of the right and non-coronary aortic cusps with severe AR extending to the abdominal aorta, and thickened mitral valve leaflets with commissural fusion with no evidence of infective endocarditis. The patient underwent urgent cardiothoracic surgery. Intraoperatively, the heart was enlarged and poorly contractile, the aortic valve was trileaflet with annular dilatation and prolapse, while the mitral valve demonstrated a “fish-mouth” appearance. He developed asystole requiring 30 minutes of cardiopulmonary resuscitation before successful double valve replacement. Histopathology of both valves revealed degenerative changes without infective or autoimmune features.Discussion While methamphetamine-associated dilated cardiomyopathy is well established, significant valvular pathology is rarely documented. Proposed mechanisms include chronic catecholamine surges resulting in sustained hypertension and shear stress on cardiac valves, promoting fibrotic and degenerative remodelling. Direct cytotoxic effects on valvular endothelial and interstitial cells may also contribute to degeneration and prolapse. In this patient, the absence of congenital, rheumatic, or infective causes, combined with histopathological findings, strongly supports methamphetamine-induced valvulopathy.Conclusion This case emphasizes that methamphetamine use may extend beyond cardiomyopathy to cause severe structural valvular disease such as AR. Clinicians should maintain a high index of suspicion for valvular involvement in young patients with heart failure and a history of stimulant abuse. Early echocardiographic evaluation and timely surgical intervention are vital for survival. This report adds to the limited literature on methamphetamine-related valvulopathy and underscores the need for greater awareness of its devastating cardiovascular effects.