Cocaine Use Presenting as Concomitant Myocardial Infraction and Transient Ischemic Attack - A Case Report

Cocaine abuse with its complications is a common problem that presents often in the emergency room. Complications of cocaine use can involve multiple systems. These complications can arise within each system simultaneously or at different times. We treated a patient who presented with symptoms of cerebrovascular accident and was found to have concomitant non-ST segment elevation myocardial infarction (NSTEMI). A 54-year-old male with medical history significant for hypertension and prior MI presented to emergency department with left leg and arm numbness first noticed when he woke up in the morning of presentation. He admitted using cocaine the night prior to presentation. Neurological exam was remarkable for decreased sensation to left extremities. His National Institute of Health Stroke Scale (NHISS) score was 1. Blood work was significant for an elevated troponin I of 1.74 ng/ml, and an elevated Creatinine of 2.34 mg/dl. CT head and MRI brain were negative for acute intracranial hemorrhage or radiological evidence of stroke. He was treated with aspirin, clopidogrel, statin and therapeutic enoxaparin for NSTEMI. His symptoms of left sided numbness resolved over the course of his stay. This case underscores why cocaine abuse should always be considered in the differential for patients presenting with symptoms suggestive of acute coronary syndrome or stroke, especially in young and middle-aged males.