Death Temporally Related To the Use of A Beta Adrenergic Receptor Antagonist In Cocaine Associated Myocardial Infarction
Death Temporally Related To the Use of A Beta Adrenergic Receptor Antagonist In Cocaine Associated Myocardial Infarction
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DOI：
10.1007/bf03160934
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发表时间：
2007-12-01
影响因子：
2.9
通讯作者：
Hoffman, Robert S.
中科院分区：
文献类型：
--
作者：
Fareed, Fareed N.;Chan, Gar M.;Hoffman, Robert S.
简介：虽然通常认为可卡因毒性患者禁用β肾上腺素能受体拮抗剂，但缺乏实际的临床证据。这种情况下，有助于突出β肾上腺素能受体拮抗剂的风险与cocaine use.Case报告：一名54岁的男子被带到急诊室（艾德）使用约1克鼻内可卡因后，胸痛的投诉。阿司匹林和硝酸甘油喷雾剂减轻了他的痛苦。尽管他仍然没有疼痛，但尽管静脉注射了15 mg地西泮，心动过速仍然存在。就诊后近2小时，给予5 mg美托洛尔治疗持续性心动过速（115次/分钟）和肌钙蛋白升高。此后不久，病人主诉胸骨下挤压性胸痛，发展无脉性电活动，无法复苏。讨论：β肾上腺素能受体拮抗剂的管理加剧可卡因诱导的动物致死性。在给予较小剂量可卡因的人类中，β肾上腺素能受体拮抗剂加剧冠状血管收缩。推测这两种效应均通过非对抗性α肾上腺素能受体激动作用发生。尽管有这些数据，但描述可卡因使用者接受β肾上腺素能受体拮抗剂后不良反应的实际病例并不常见。该病例支持可卡因-β肾上腺素能受体拮抗剂相互作用的潜在致死性。
Introduction: Although it is commonly stated that the use of beta adrenergic receptor antagonists is contraindicated in patients with cocaine toxicity, actual clinical evidence of harm is lacking. This case helps to highlight the risks of beta adrenergic receptor antagonists in patients with chest pain associated with cocaine use.Case Report: A 54-year-old man was brought to the emergency department (ED) complaining of chest pain after using approximately 1 gram of intranasal cocaine. Aspirin and nitroglycerin spray relieved his pain. Although he remained pain free, tachycardia persisted despite 15 mg of diazepam intravenously. Nearly two hours after presentation, a total of 5 mg of metoprolol was given for persistent tachycardia (115/minute) and an elevated troponin. Shortly thereafter, the patient complained of crushing substernal chest pain, developed pulseless electrical activity, and could not be resuscitated.Discussion: The administration of beta adrenergic receptor antagonists exacerbates cocaine-induced lethality in animals. In humans given smaller doses of cocaine, beta adrenergic receptor antagonists exacerbate coronary vasoconstriction. Both effects are presumed to occur through unopposed alpha adrenergic receptor agonism. Despite these data, actual cases describing adverse effects in cocaine users given beta adrenergic receptor antagonists are uncommon. This case supports the potential lethality of a cocaine-beta adrenergic receptor antagonist interaction.