IMAGES IN EMERGENCY MEDICINE
Cocaine induced non-ST-elevation myocardial infarction: an uncommon electrocardiographic presentation
University of Florida Jacksonville, Department of Internal Medicine, Jacksonville, USA
Correspondence to:
Correspondence to:
F J Arnaldo
University of Florida Jacksonville, Department of Internal Medicine, Jacksonville, FL 32209, USA; farnaldo@gmail.com
Accepted 17 March 2006
Keywords: cocaine; myocardial infarction; ST segment depression
| The first 150 words of the full text of this article appear below. |
The incidence of myocardial infarction in cocaine associated chest pain is approximately 6%.1 The most common cocaine induced electrocardiogram changes are non-specific ST segment changes, ST segment elevation, T wave inversion, and QT interval prolongation.
A young man was brought to the emergency department after having taken intranasal cocaine. He was agitated, tachycardic, hypertensive, and complaining of substernal, pressure-like chest pain. The electrocardiogram showed sinus tachycardia and a large magnitude ST segment depression in all leads except aVL and V2, and ST segment elevation in leads aVR and V1 (fig 1
). Treatment with nitroglycerin infusion and aspirin was initiated, the chest pain resolved, and the electrocardiogram normalised. Cardiac enzymes showed a typical rise and fall curve. A two-dimensional echocardiogram, performed after the chest pain had subsided, showed normal left ventricular systolic function with no segmental wall motion abnormalities. The patient refused cardiac catheterisation and left the hospital against medical
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Kuczkowski, K M
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