From: <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, June 27, 2000 10:24 AM
Subject: Cocaine and MIs
> Heres a scenario. I would be interested in your thoughts.
> 30 year old chap
> Typical history and ECG changes compatable with MI meeting thrombolysis
criteria..except
> he has taken Cocaine for recreation and has a tachycardia and is
hypertensive.
>
> Q1 Is his MI due to excess Oxygen demand from his over active myocardium
or
> is it corpnary artery spasm ?
Cocaine does also have thrombogenic effect, as well as accelerated
coronarian disease.
> Q2 Does he therefore have a thrombotic event in his coronary arteries?
Could really. Not much way to know now. Except going to cath lab now.
> Q3 Can you thrombolyse him IF you can slow him up and lower his BP with
Beta
> Blockade ?
Yes, but I would not use BetaBlocker, fear is to push up pressure by
blocking peripheral Beta receptor and let unopposed alpha stimulation
increase BP. Labetalol could be a choice, but many fear his alpha blocking
activitie is not anough. Certainly benzo would be my first (and probably
effective) choice.
> Q4 Can you give BBs to him at all?
Would not try alone.
> Q5 having never seen this scenario in real life..how fast a tachy do they
get
> and how hypertensive can they get?
As fast and as high it can be.
> Q6 Any other interesting points..such as increased complication rates etc?
Be patient, take your time and wait to see what will happend before acting.
Cheers,
Alain Vadeboncoeur MD
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