Myocardial infarction associated with inappropriate use of topical cocaine as treatment for epistaxis.
A case of a 57-year-old man with hypertension and stable angina, on aspirin therapy, who was treated for epistaxis with intranasal cocaine, and who subsequently suffered a non-Q wave myocardial infarction is reported. Of note, the cocaine was administered in a manner which differs from that advocated in standard references. Specifically, intranasal packing soaked with 4% cocaine was left in place with continuous nasal mucous membrane contact over 5 to 6 hours. The authors speculate that myocardial infarction occurred on the basis of coronary artery spasm. This case should alert practitioners to myocardial ischemia occurring as a complication of the therapeutic use of intranasal cocaine for the treatment of epistaxis.
Ross
G S
GS
Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, NH.
Bell
J
J
D000281:Administration, Intranasal; D003042:Cocaine / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D004562:Electrocardiography; D004844:Epistaxis / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000503:physiopathology
D003042:Cocaine