Cocaine-associated myocardial infarction.
Myocardial ischaemia and infarction has become a well-recognized sequelae of cocaine use. The possibility of recent cocaine use should be assessed in patients with potential myocardial ischaemia because the treatment of patients with myocardial ischaemia related to cocaine differs from that of patients with myocardial ischaemia unrelated to cocaine. Patients with cocaine-associated myocardial ischaemia should receive initial treatment with benzodiazepines to decrease central adrenergic stimulation. Aspirin should be used to reduce thrombus formation, and nitroglycerin to reverse coronary vasoconstriction. Patients with continued ischaemia can be treated with either low doses of phentolamine, or verapamil. If ischaemia continues after treatment with these agents mechanical reperfusion or thrombolytic therapy should be considered depending upon the clinical circumstances. Patients with myocardial ischaemia secondary to cocaine should not receive treatment with beta adrenergic antagonists as these agents enhance coronary vasoconstriction thereby worsening ischaemia.
Hollander
J E
JE
Department of Emergency Medicine, University Medical Center, Stony Brook, New York 11794-8350, USA.
D000328:Adult; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D001569:Benzodiazepines / Q000627:therapeutic use; D003042:Cocaine / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000188:drug therapy; D017202:Myocardial Ischemia / Q000139:chemically induced; D005996:Nitroglycerin / Q000627:therapeutic use; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019966:Substance-Related Disorders; D014665:Vasodilator Agents / Q000627:therapeutic use
D010975:Platelet Aggregation Inhibitors; D014665:Vasodilator Agents; D001569:Benzodiazepines; D005996:Nitroglycerin; D003042:Cocaine; D001241:Aspirin