At a rave, a 19-year-old woman ate what her doctors later described as "small, rounded chocolate chips containing unidentified pills." About three hours later, she developed severe chest and back pain radiating to her left shoulder, palpitations, confusion, incoherent speech, and a surge of energy that kept her from sleeping.
Doctors at the American University of Beirut Medical Center in Lebanon found she had a rare reversed form of stress-induced heart muscle injury. After she recovered enough to go home, she came back with blood clots blocking arteries in her abdomen and pelvis. Her case report in Clinical Practice and Cases in Emergency Medicine was published online in November 2025.
That night she had also taken marijuana edibles and multiple energy drinks. Her urine drug screen was positive for amphetamines and THC.
A Heart That Looked Like a Heart Attack
When she reached the emergency department, roughly 12 to 14 hours after eating the chips, her heart was beating 137 times a minute, and her pupils were dilated. Her ECG showed ST-segment elevation, a pattern doctors usually link to a heart attack. Troponin, a marker of heart muscle injury, was 1.048 ng/mL, far above the reference limit of 0.03.
An ultrasound of her heart explained what was going on. The base and middle of the left ventricle were barely moving, while the tip was pumping hard. Her ejection fraction, the share of blood pumped out with each beat, had fallen to about 35% to 39%. A normal heart pumps out roughly 50% to 70%.
This is reverse, or basal, Takotsubo cardiomyopathy. It is a mirror image of classic broken heart syndrome, in which the tip of the heart balloons out while the base keeps squeezing. Data from the International Takotsubo Registry, summarized in a 2025 Journal of Cardiology review, put the basal pattern at just 2.2% of cases. Patients with non-classic patterns tend to be younger.
Because she was young, her symptoms were improving and nothing suggested blocked coronary arteries, doctors decided against cardiac catheterization. In the cardiac care unit she received IV fluids, oxygen and IV diazepam and was started on the heart-rate drug ivabradine. She went home 48 hours later, after her symptoms had resolved.
The Clots That Showed Up After Discharge
Thirty hours after she left the hospital, she came back with pain around her belly button and nausea. A CT angiogram showed a clot in her left renal artery, completely blocking one branch and partly blocking another, which had caused an infarct (an area of dead tissue) in her kidney. It also showed a clot blocking her right internal iliac artery, a major vessel in the pelvis. Her kidney function had worsened.
She was treated with aspirin and a heparin drip. A repeat ultrasound showed her heart had recovered, with an ejection fraction of 60%. She went home on blood thinners and heart medications.
The authors note that amphetamines can promote clotting by "increasing endothelial tissue factor expression, impairing natural anticoagulants and causing vascular inflammation." The drug was probably not the only cause, though. Testing found a heterozygous MTHFR mutation, and several relatives had a history of blood clots. The authors wrote that these factors "may have collectively contributed" to her clots.
Stimulants and the Stressed Heart
Takotsubo is thought to happen when a flood of stress hormones stuns the heart muscle. A StatPearls chapter on its causes says catecholamine levels in these patients can run two to three times higher than normal, and its list of triggers includes cocaine and "excessive stimulants." Methamphetamine drives the release of large amounts of dopamine and norepinephrine, which the authors see as the likely link in their patient.
The National Institute on Drug Abuse lists rapid and irregular heartbeat, increased blood pressure, stroke and kidney damage among the short-term risks of methamphetamine. A 2020 review in the Journal of the American Heart Association cited data showing that methamphetamine-associated cardiomyopathy rose from 1.8% of new cardiomyopathy cases in Southern California in 2009 to 5.6% in 2014. Takotsubo and reverse Takotsubo patterns have both been described.
The case report cannot establish which amphetamine was involved. The pills were never analyzed, and while the screen was positive for amphetamines, the authors frame the case as methamphetamine toxicity.
A Warning for Emergency Rooms
The authors' main message is for emergency doctors. Reverse Takotsubo, they write, is "often misdiagnosed, especially in young or atypical patients," and "clinicians must suspect cardiac issues and ensure close follow-up in young stimulant users." This patient's clots appeared only after she was sent home.
Most people with Takotsubo do well. The American Heart Association says most make a full recovery within weeks, although the condition can be fatal in rare cases.
U.S. overdose deaths are also falling. Provisional data released by the CDC in May 2026 showed that overdose deaths dropped almost 14% in 2025 compared with 2024, and deaths involving psychostimulants such as methamphetamine decreased as well. This case shows a separate risk: when a drug is hidden inside a snack, the person eating it may have no idea what the drug is or how much they are taking.
Anyone who has chest pain, a pounding heart or confusion after taking an unknown substance should get emergency care right away. New abdominal or leg pain in the days afterward also needs medical attention.
Key Questions Answered
What happened to the patient?
After eating chocolate chips that contained unidentified pills at a rave, a 19-year-old developed reverse Takotsubo cardiomyopathy. After going home, she developed clots in a kidney artery and a pelvic artery.
What is reverse Takotsubo cardiomyopathy?
It is a rare form of stress-induced heart muscle dysfunction. The base of the heart weakens while the tip keeps pumping, the opposite of the classic pattern.
Was the drug definitely an amphetamine?
Her urine tested positive for amphetamines and THC, but the pills themselves were never identified or analyzed.
Did she recover?
Her heart function returned to normal, with an ejection fraction of 60%, before her second discharge. Long-term follow-up was not reported.
Were the clots caused only by the drug?
Probably not. The authors say a genetic variant and a family history of clotting may also have contributed.
What should someone do after taking an unknown pill or edible?
Chest pain, a racing heart, confusion, or severe agitation need emergency care. New pain in the days that follow should also be checked.
Published by Medicaldaily.com
