title: Cardiovascular toxicity of cocaine of iatrogenic origin. Case report.
abstract: The use of cocaine as an illicit drug is associated with various cardiovascular events. In recent decades, because of growing levels of consumption, there has been an increasing incidence of these complications. At the same time, cocaine is also widely used as a local anesthetic, mainly in nasal surgery. Its application in this context is controversial due to the potential associated adverse effects. The authors report the case of a 29-year-old patient, with no known cardiovascular risk factors, admitted for elective nasal surgery, under general anesthesia combined with topical application of cocaine. During surgery the patient developed hemodynamic instability in the context of ventricular arrhythmias, after which she presented evolving electrocardiographic changes and increased levels of myocardial necrosis markers, diagnostic of non-ST-segment elevation acute coronary syndrome. The authors review the cardiovascular complications associated with cocaine use and the underlying pathophysiologic mechanisms and discuss the role of cocaine as a topical anesthetic.
authors.affiliation: Serviço de Cardiologia, Hospital de São Marcos, Braga, Portugal.
authors.forename: Márcia
authors.initials: M
authors.lastname: Torres
authors.forename: Sérgia
authors.initials: S
authors.lastname: Rocha
authors.forename: Adília
authors.initials: A
authors.lastname: Rebelo
authors.forename: Jorge
authors.initials: J
authors.lastname: Marques
authors.forename: Sérgio
authors.initials: S
authors.lastname: Nabais
authors.forename: Peidro
authors.initials: P
authors.lastname: Azevedo
authors.forename: Sónia
authors.initials: S
authors.lastname: Magalhães
authors.forename: João
authors.initials: J
authors.lastname: Costa
authors.forename: Adelino
authors.initials: A
authors.lastname: Correia
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced*; D000328:Adult; D000779:Anesthetics, Local / Q000009:adverse effects*; D003042:Cocaine / Q000009:adverse effects*; D015521:Ethmoid Sinusitis / Q000601:surgery; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D015523:Maxillary Sinusitis / Q000601:surgery
chemical_list: D000779:Anesthetics, Local; D003042:Cocaine