Chest
Selected ReportsSerial Angiography in Cocaine-Induced Myocardial Infarction
Section snippets
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
REFERENCES (13)
- et al.
Recurrent myocardial infarction associated with cocaine abuse in a young man with normal coronary arteries: evidence for coronary artery spasm culminating in thrombosis
J Am Coll Cardiol
(1987) - et al.
Alleviation of cocaine-induced coronary vasoconstriction by nitroglycerin
J Am Coll Cardiol
(1991) - et al.
Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil
Am J Cardiol
(1994) - et al.
Cocaine-associated myocardial infarction: clinical safety of thrombolytic therapy
Chest
(1995) - et al.
Cocaine-induced myocardial infarction in patients with normal coronary arteries
Ann Intern Med
(1991) - et al.
Cardiac complication from use of cocaine and phenylephrine in nasal septoplasty
Arch Otolaryngol Head Neck Surg
(1995)
Cited by (0)
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