CASE

Stimulant drugs, including cocaine and amphetamines, are well-established risk factors for cardiac events. Other indigenous recreational drugs have also been proposed as potential cardiac risk factors, but due to a lack of awareness in cross-cultural medicine and limited evidence, these drugs are often overlooked.

We report a case of a 59-year-old Yemeni male with a history of chewing the stimulant plant Catha edulis (Khat) who presented to us in the Northwest Family Medicine clinic, with multiple occurrences of acute coronary syndrome (ACS) and stroke/transient ischemic attack (TIA).

The patient has a past medical history of three CVA/TIA events, dilated cardiomyopathy with a reduced ejection fraction of 30-35%, coronary arteriosclerosis, hyperlipidemia, hypertensive disorder, type 2 diabetes mellitus without complications, anemia, and GERD, and a history of Khat abuse. He used to chew Khat daily while in Yemen about 30 years ago and states that it was a common practice in Yemeni culture. Currently, he chews Khat occasionally every two weeks or on special occasions.

Multiple CT and MRI scans were performed at an outside facility and confirmed the CVA events.