Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA.
Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA.
Cardiovasc Toxicol. 2021 Jun;21(6):490-493. doi: 10.1007/s12012-021-09635-4. Epub 2021 Feb 3.
Cocaine use accounts for 40% of the annual drug use related emergency department visits in the United States. Cocaine use is hence recognized as a major health problem. Cocaine blocks the presynaptic reuptake of norepinephrine and dopamine. The resulting increased adrenergic activity leads to vasoconstriction. Additionally, via various mechanisms, cocaine leads to a prothrombotic state and increases myocardial demand. Cocaine can cause coronary vasospasm and is therefore, associated with acute myocardial injury even in the absence of pre-existing atherosclerotic coronary artery disease. Nitroglycerin has a class 1C indication by the ACCF/AHA guidelines for patients with ST-segment elevation or depression that accompanies ischemic chest discomfort in the setting of cocaine use. It has been shown to reverse cocaine-induced coronary vasospasm and chest pain. In this case report, for the first time, we discuss how intravenous administration of high dose nitroglycerin to a patient in pulseless ventricular tachycardia with angiographically confirmed vasospasm induced by cocaine resulted in return of spontaneous circulation.
在美国，可卡因的年使用率占与毒品使用相关的急诊就诊率的 40%。因此，可卡因的使用被认为是一个主要的健康问题。可卡因会阻断去甲肾上腺素和多巴胺的突触前再摄取。由此导致的肾上腺素能活性增加会导致血管收缩。此外，可卡因通过各种机制导致血栓形成状态，并增加心肌需求。可卡因可引起冠状动脉痉挛，因此，即使在没有先前存在的动脉粥样硬化性冠状动脉疾病的情况下，也与急性心肌损伤相关。美国心脏病学会基金会/美国心脏协会指南将硝酸甘油列为 1C 类药物，用于伴有缺血性胸痛的 ST 段抬高或压低的患者，这些患者在使用可卡因的情况下伴有缺血性胸痛。它已被证明可逆转可卡因引起的冠状动脉痉挛和胸痛。在本病例报告中，我们首次讨论了静脉注射大剂量硝酸甘油如何使一名患有可卡因引起的血管痉挛的无脉性室性心动过速患者恢复自主循环，该患者的血管痉挛已通过血管造影证实。
