Journal
CARDIOVASCULAR TOXICOLOGY
Volume 21, Issue 6, Pages 490-493Publisher
HUMANA PRESS INC
DOI: 10.1007/s12012-021-09635-4
Keywords
Cocaine-induced coronary vasospasm; ST elevation myocardial infarction; Coronary vasospasm; Nitroglycerin
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Cocaine use accounts for 40% of drug-related emergency department visits in the US and is recognized as a major health problem. Cocaine blocks the reuptake of norepinephrine and dopamine, causing vasoconstriction and increased myocardial demand. Nitroglycerin is effective in reversing cocaine-induced coronary vasospasm and chest pain.
Cocaine use accounts for 40% of the annual drug use related emergency department visits in the United States. Cocaine use is hence recognized as a major health problem. Cocaine blocks the presynaptic reuptake of norepinephrine and dopamine. The resulting increased adrenergic activity leads to vasoconstriction. Additionally, via various mechanisms, cocaine leads to a prothrombotic state and increases myocardial demand. Cocaine can cause coronary vasospasm and is therefore, associated with acute myocardial injury even in the absence of pre-existing atherosclerotic coronary artery disease. Nitroglycerin has a class 1C indication by the ACCF/AHA guidelines for patients with ST-segment elevation or depression that accompanies ischemic chest discomfort in the setting of cocaine use. It has been shown to reverse cocaine-induced coronary vasospasm and chest pain. In this case report, for the first time, we discuss how intravenous administration of high dose nitroglycerin to a patient in pulseless ventricular tachycardia with angiographically confirmed vasospasm induced by cocaine resulted in return of spontaneous circulation.
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