Chest
Volume 111, Issue 3, March 1997, Pages 822-824
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Selected Reports
Serial Angiography in Cocaine-Induced Myocardial Infarction

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A young man suffered an acute inferior myocardial infarction following clinical use of cocaine as topical anesthesia. Coronary angiography showed occlusion of both the posterior descending and posterolateral arteries which was resistant to intracoronary administration of nitroglycerin and verapamil, a finding consistent with thrombotic occlusion. A subsequent angiogram 3 months later showed no residual lesions.

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CASE REPORT

A 29-year-old man, a nonsmoker with no coronary risk factors, underwent septoplasty and reduction of turbinates. Local anesthesia was achieved with injection of 0.5% lidocaine hydrochloride (Xylocaine) and application of a thin film of 12.5% cocaine hydrochloride and 0.1% epinephrine paste to the nasal mucosa. The surgery was uneventful, but 4½ h later he developed chest pain radiating to the left arm and jaw. He first reported symptoms 6 h after surgery when he was found to be sweaty with a

DISCUSSION

The occurrence of two occluded arteries seen in this and other cases5 is consistent with a systemic effect of cocaine, which may act at more than one vascular site. Intranasally administered cocaine is known to cause coronary vasoconstriction,3 platelet activation,6 and platelet α-granule release.7 In addition, intense coronary vasoconstriction may itself damage the endothelium, thereby increasing the likelihood of platelet adhesion and thrombus formation.8 These factors may explain coronary

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