CCU - Cocaine may cause symptoms of MI

Diary/Dairy, RN · Mar 18, 2008

We had a few cardiac arrests at my old job from cocaine use - but I did not know that clot busters and beta blockers were contraindicated when someone had used cocaine. Intersting.

angel337, MSN, RN · Mar 18, 2008

"do you use any illegal drugs" is a routine question in the ER for young people with chest pain. it is a known fact that cocaine can cause cardiac damage. usually the ckmb is elevated. i see this quite often.

TazziRN, RN · Mar 18, 2008

This has long been known to ER/ICU folks. It not only can cause symptoms of MI, it can cause an MI.

Diary/Dairy, RN · Mar 18, 2008

I guess what I wanted to note was that Metoprolol and clot busters will make things worse. I too knew that cocaine would bring about an MI or arrest.

Editorial Team / Admin · Mar 18, 2008

In the cocaine pt:

The use of thrombolytics carries a huge risk for cerebral hemorrhage.

Beta blockers can cause severe hypertension and coronary artery constriction.

UM Review RN, ASN, RN · Mar 18, 2008

Although I knew that coke use could cause chest pain and/or MI, I had no idea that BB's and thrombolytics were contraindicated.

What about Nitro? Does it help or hurt?

What about crack? Isn't that a form of cocaine? So if someone's been smoking it, they're at the same level of risk, I assume.

Editorial Team / Admin · Mar 18, 2008

quote=Angie O'Plasty, RN;2721018]Although I knew that coke use could cause chest pain and/or MI, I had no idea that BB's and thrombolytics were contraindicated.

What about Nitro? Does it help or hurt?

Yes, it helps, once MI is dx, utilize oxygen, ASA, nitro, benzos and phentolamine.

What about crack? Isn't that a form of cocaine? So if someone's been smoking it, they're at the same level of risk, I assume.

Yes, it is a form. And, same level of risk - even more so (same as IV) for the onset is almost instantaneous leading to vasoconstriction and myocardial ischemia due to decreased oxygenation.

Miami NightNurse · Mar 18, 2008

Thank You all for the info. I added it to the Cardiac Handbook I wrote. Wow learn something new every day!!!!! Can't believe as long as I've worked in Cardiovascular I didn't know that. Then again I've never had a fresh Cocaine MI, The ones we have had, have always been in such bad shape they went to ICU.

Editorial Team / Admin · Mar 18, 2008

Thank You all for the info. I added it to the Cardiac Handbook I wrote. Wow learn something new every day!!!!! Can't believe as long as I've worked in Cardiovascular I didn't know that. Then again I've never had a fresh Cocaine MI, The ones we have had, have always been in such bad shape they went to ICU.

You're welcome.

You'll find the majority (not all) cocaine-related MIs have low mortality rates, too. The benzos and oxygen do a great job managing chest pain in most all pts. (that I've seen).

Diary/Dairy, RN · Mar 18, 2008

Thanks all for posting - that was great info - and I, for one, am always on the lookout to learn new things. :)

RedCell · Mar 19, 2008

In the cocaine pt:
The use of thrombolytics carries a huge risk for cerebral hemorrhage.
Beta blockers can cause severe hypertension and coronary artery constriction.

Actually dude, the beta blockade causes alpha 1 domination throughout Tupac. This vasoconstriction from the alpha 1 agonism of the crack rock is already causing an increase in preload that slows the heart down (bainbridge reflex). Completely block out the stimulus for the heart to lub/dub (beta 1 receptors) and bang Tupac is now dead, or at least pushing for asystole. We occasionally push labetalol on these dudes because of its 7:1 ratio of alpha/beta antagonism. Really think that a vasodilator like nitro or nicardipine would be superior though.