Cardiac Arrest Associated With Psilocybin Use and Hereditary Hemochromatosis

A 48-year-old man with attention-deficit/hyperactivity disorder taking lisdexamfetamine experienced a fainting episode and was found to be in ventricular fibrillation. Extensive cardiac testing, including MRI and electrophysiology, revealed no underlying cause. He received an implantable defibrillator and was later diagnosed with hereditary hemochromatosis. His combination of medications may have triggered catecholamine release, leading to the dangerous heart rhythm.

Study at a glance

Abstract

Recreational drug use is a significant public health concern in various countries. It is well understood that usage of psychedelics/hallucinogens, such as lysergic acid diethylamide (LSD), ecstasy, phencyclidine (PCP), and psilocybin-containing mushrooms, has increased significantly over the last few decades, particularly in adolescents and young adults, yet the effects of these recreational drugs are poorly understood. Psilocybin has recently been studied as an alternative to traditional antidepressant therapies with potentially benign side effects. Here, we present the case of a 48-year-old male with a past medical history of attention-deficit/hyperactivity disorder on lisdexamfetamine who presented after a syncopal episode witnessed by his wife at home. He was found to be in ventricular fibrillation and subsequently had an extensive workup with cardiac magnetic resonance imaging (MRI), ischemic evaluation, and electrophysiology, which were unrevealing. He then received an automatic implantable cardiac defibrillator and was incidentally found to have hereditary hemochromatosis on outpatient follow-up. His polypharmacy may have potentially led to catecholamine release, leading to ventricular arrhythmia.