Article Text

Download PDFPDF
Thrombosis within the left anterior descending coronary artery and left ventricle after high-dose nitrous oxide use
  1. Remko S Kuipers,
  2. Aron J Paes,
  3. Giovanni Amoroso and
  4. Robert K Riezebos
  1. Cardiology, OLVG, Amsterdam, The Netherlands
  1. Correspondence to Dr Remko S Kuipers; R.S.kuipers{at}


We present a man in his 30s with acute anterior myocardial infarction due to thrombotic occlusion of the left anterior descending artery and subsequent left ventricular thrombus formation after high-dose recreational use of nitrous oxide (N2O). Initial questioning for use of illicit substances was negative, but low vitamin B12 levels and severely elevated homocysteine levels prompted us to interrogate for the use of laughing gas. On questioning, the patient admitted to have used this substance, which he presumed to be innocent. Neither percutaneous coronary intervention with balloon dilatation nor intravenous glycoprotein IIb/IIIa receptor antagonist, nor continuous use of anticoagulation and double antiplatelet therapy resulted in thrombus resolution. Due to a severely reduced left ventricular function, despite 3 months on heart failure therapy, the patient is being counselled for intracardiac defibrillator implantation. We conclude that N2O, notably when consumed in conjunction with other proatherogenic substances, is associated with thrombosis: a relation possibly mediated by severe hyperhomocysteinaemia.

  • Ischaemic heart disease
  • Interventional cardiology
  • Haematology (incl blood transfusion)

Statistics from


  • Contributors RSK and AJP wrote the manuscript. GA and RKR reviewed and commented on the manuscript. All were involved in treatment of the patient.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.