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Published on: February 5, 2011
Concurrent myocardial and cerebral infarctions after intranasal cocaine use
1Department of Neurology, University of Maryland School of Medicine, Baltimore.
Insights
Cocaine abuse can cause heart attack and stroke. This case report details a patient experiencing both myocardial infarction and cerebral infarction after cocaine use, highlighting a potential link between cardiac events and stroke.
Area of Science:
- Cardiology
- Neurology
- Toxicology
Background:
- Cocaine abuse is linked to cardiovascular and cerebrovascular events.
- Concurrent cardiac disease and stroke from cocaine use is rare.
- This report details a unique case of simultaneous cardiac and neurological complications.
Observation:
- A 37-year-old man with a history of substance abuse developed chest pain and ventricular tachycardia after intranasal cocaine use and exercise.
- The patient experienced atrial fibrillation, myocardial infarction, and a left hemisphere stroke within hours of cocaine ingestion.
- Electrophysiologic testing revealed inducible ventricular tachycardia.
Findings:
- This is the first reported case of concurrent myocardial infarction, ventricular arrhythmias, and cerebral infarction linked to cocaine use.
- Cocaine use may precipitate stroke by triggering cardiac embolism from a pre-existing source.
- The temporal relationship between cocaine use, cardiac events, and stroke is strongly suggested.
Implications:
- Clinicians should be aware of the potential for severe, simultaneous cardiac and neurological complications in cocaine users.
- Early recognition and intervention are crucial for managing cocaine-induced cardiovascular and cerebrovascular events.
- Understanding the mechanisms of cocaine toxicity is vital for preventing these life-threatening outcomes.
Background And Purpose:
Cardiac and cerebrovascular complications associated with cocaine abuse have increasingly been reported, but concurrent development of cocaine-induced cardiac disease and stroke has rarely been reported.
Case Description:
A 37-year-old man with a remote history of intravenous heroin and amphetamine use, cardiomyopathy, and recent cocaine use developed chest pain and ventricular tachycardia 30 minutes after intranasal cocaine hydrochloride use and jogging on a cold winter morning. Ventricular tachycardia was converted to atrial fibrillation. He was proven to have a small myocardial infarction. Within 6 hours of cocaine use he suffered a left hemisphere stroke. Cardiac electrophysiologic evaluation revealed inducible ventricular tachycardia.
Conclusions:
To our knowledge, this is the first report of concurrent myocardial infarction, life-threatening ventricular arrhythmias, and cerebral infarction temporally related to cocaine use. It is probable that one mechanism by which cocaine use causes stroke is to trigger expression of a known cardiac source of embolism.
