Cocaine Induced Cardiomyopathy Presenting with Cardiac Arrest: Insights from Cardiac Magnetic Resonance

Cocaine abuse is associated with a broad spectrum of cardiovascular complications, including myocardial ischemia, arrhythmias, and cardiomyopathy. However, chronic myocardial injury may remain subclinical, delaying diagnosis until an acute event occurs. We present the case of a 49-year-old man with a history of chronic cocaine use who was admitted following an out-of-hospital cardiac arrest. A post-Return of Spontaneous Circulation Point-of-Care Ultrasound revealed mildly reduced left ventricular systolic function, while coronary angiography excluded obstructive coronary artery disease. Cardiac magnetic resonance (CMR) imaging demonstrated mid-wall late gadolinium enhancement and patchy T1 elevation, consistent with nonischemic myocardial fibrosis and edema. A subcutaneous implantable cardioverter-defibrillator was placed for secondary prevention, and beta-blocker therapy was initiated. Genetic testing for inherited arrhythmogenic and cardiomyopathic conditions was also undertaken. This case underscores the potential for clinically silent cocaine-induced cardiomyopathy and highlights the value of CMR in detecting subclinical myocardial injury.