Myocardial Infarction With Topical Cocaine Anesthesia for Nasal Surgery

Chiu, Yi‐Chun; Brecht, Karen M.; Dasgupta, D; Mhoon, Ernest

doi:10.1001/archotol.1986.03780090084017

Cited by 84 publications

(17 citation statements)

References 9 publications

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“…It was first used as a local anesthetic in 1884 and, interestingly, was used as an ingredient in a popular cola beverage in the early 20th century. 5 The alkaloid is dissolved in hydrochloric acid to form the water-soluble salt cocaine hydrochloride that can exist in crystalline, powder, and granular form. Freebase cocaine is the alkaloid in a basic non-salt form, prepared from cocaine hydrochloride by an organic extraction from a basic solution with ether.…”

Section: Pharmacologymentioning

confidence: 99%

Cocaine and the Heart

Maraj

Figueredo

Morris

2010

Clinical Cardiology

116

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The use of cocaine may be associated with either acute or chronic toxicity, and approximately 5% to 10% of emergency department visits in the United States are believed to be secondary to cocaine usage. Chest pain is the most common cocaine‐related medical problem, leading to the evaluation of approximately 64 000 patients annually for possible myocardial infarction, of which approximately 57% are admitted to the hospital, resulting in an annual cost greater than $83 million. There is a plethora of cocaine‐related cardiovascular complications, including acute myocardial ischemia and infarction, arrhythmias, sudden death, myocarditis, cardiomyopathy, hypertension, aortic ruptures, and endocarditis. There is no evidence to suggest that preexisting vascular disease is a prerequisite for the development of a cocaine‐related cardiovascular event, although it may be a potentiating factor, as may be nicotine and alcohol. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Pharmacologymentioning

confidence: 99%

Cocaine and the Heart

Maraj

Figueredo

Morris

2010

Clinical Cardiology

116

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“…perfusion * vasoconstriction * pressure I ncreased cocaine use in the United States has resulted in continued reports of cocaine-related cardiomyopathy and ischemic coronary syndromes.1,2 Cocaine cardiomyopathy has been described in many case reports, yet the pathogenesis of this syndrome is largely unexplained.3,4 Cocaine use has been associated with premature coronary stenosis and ventricular hypertrophy, but these have not been prerequisite for myocardial infarction.5-7 In more than 100 reported cases of cocaine-related myocardial infarction, only 2 cases of focal coronary spasm have been observed at coronary catheterization.5'8 Cocaine-related myocardial infarction without fixed coronary artery disease has also been reported in the setting of rhinolaryngolic surgery. 9 Controlled conscious human studies demonstrate only modest epicardial coronary constriction without evidence of ischemia. 10 Thus, the clinical evidence for a relation between the ischemic syndromes of cocaine and coronary constriction is weak, and the pathophysiology of the inotropic and coronary effects of cocaine remains controversial.…”

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confidence: 99%

Intracoronary versus intravenous effects of cocaine on coronary flow and ventricular function.

et al. 1994

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We conclude that the effects of acute cocaine exposure on ventricular function are predominantly direct but of brief duration and therefore probably not clinically relevant. The effects of cocaine on coronary tone are predominantly indirect and biphasic, with early vasodilation followed by mild and more prolonged vasoconstriction. In the absence of coronary stenosis or ventricular hypertrophy, this small amount of vasoconstriction is unlikely to cause ischemia.

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“…Reports of iatrogenic cardiac complications on the other hand, are more rare. A search through literature revealed only 7 case reports of significant cardiotoxicity after the topical application of cocaine in nasal surgery, most of whom presented with myocardial ischemia, non ST-segment elevation myocardial infarction (NSTEMI) or ventricular arrhythmias [4–6,8–10]. Only one case showed ST-segment elevation myocardial infarction (STEMI) [7] but coronary angiography was normal in this patient, as it was in other cases when coronary angiography was performed.…”

Section: Discussionmentioning

confidence: 99%

Coronary spasm after the topical use of cocaine in nasal surgery

et al. 2013

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SummaryBackground:Cocaine is a frequently used recreational drug which imposes important health problems with even life-threatening cardiotoxicity. The therapeutic use of cocaine is nowadays restricted to topical anesthesia in ophthalmological and nasal surgery but the possible hazards of this local anesthesia are not always fully appreciated.Case Report:A 51-year old male patient with moderate cardiovascular risk profile underwent elective nasal surgery and cocaine was used as a local anesthetic. During surgery, ventricular arrhythmias and cardiogenic shock occurred, mimicking an ST-segment elevation myocardial infarction (STEMI) in sinus rhythm. Coronary angiography showed diffuse spasm of the right coronary artery (RCA) which disappeared with intracoronary nitrates. Urine analysis was positive for cocaine. The patient recovered completely with a normal echocardiography and ECG at discharge.Conclusions:Cocaine cardiotoxicity is not uncommon in the community but a particular situation arises when used in medicine as a topical anesthetic. This is the first case report, to our knowledge, of a cardiogenic shock mimicking a STEMI with documentation of diffuse coronary spasm after cocaine use in nasal surgery. One must be aware of the potential life-threatening complications in this low-risk surgery, moreover when safer alternatives are available.

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Myocardial Infarction With Topical Cocaine Anesthesia for Nasal Surgery

Cited by 84 publications

References 9 publications

Cocaine and the Heart

Cocaine and the Heart

Intracoronary versus intravenous effects of cocaine on coronary flow and ventricular function.

Coronary spasm after the topical use of cocaine in nasal surgery

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