Coronary artery vasospasm induced by cocaine (maybe)

2.5 out of 5 stars Cocaine-Induced Coronary Artery Vasospasm. Almaddah N, Ajayi TO. N Engl J Med 2016 Feb 4;374:e5 Full Text with video In a series of amazing studies that are now about three decades old, Richard Lange and his colleagues at Parkland Hospital in Dallas investigated the cardiovascular effects of administering intranasal cocaine to patients to patients during cardiac catheterization for routine workup of chest pain. In an initial study, the group demonstrated that cocaine produced coronary artery vasoconstriction that was relieved by nitroglycerin and exacerbated by smoking a cigarette and also by administering a beta-blocker. This brief case report in the New England Journal of Medicine’s “Images in Clinical Medicine” series could be an excellent real-life illustration of Lange’s discoveries, if it weren’t for some critical flaws (more on these in a minute.) A 58-year-old woman comes to the emergency department complaining of chest pain on and off for 2 days. The pain goes away after she is given nitroglycerin SL and acetaminophen with hydrocodone (!). A recent coronary angiogram was unremarkable. Her initial troponin level was minimally elevated at 0.04 ng/ml (reference range 0.0 – 0.03 ng/ml). At 6 hours the troponin level increased to 5.7 ng/ml and a transthoracic echocardiogram showed a small pericardial effusion and normal cardiac function without wall motion abnormalities. She was admitted with a diagnosis of ...
Source: The Poison Review - Category: Toxicology Authors: Tags: Medical cardiovascular effects cocaine coronary artery vasospasm Source Type: news