Intratracheal cocaine induced myocardial infarction: an unusual complication of fibreoptic bronchoscopy

Abstract

A 73 year old man developed chest pains 5 minutes after fibreoptic bronchoscopy. The procedure had been performed without sedation following an intratracheal injection of 5 ml 2.5% cocaine solution and xylocaine spray to the pharynx for topical anaesthesia. A 12-lead electrocardiogram showed an evolving anterior myocardial infarction. Cardiac catheterisation revealed coronary artery spasm in the proximal left anterior descending artery at the site of non-significant plaque disease. The risk factors, mechanisms, and treatment of cocaine induced myocardial infarction following intratracheal injections are discussed.C ardiovascular complications of fibreoptic bronchoscopy, although infrequent, are more common in the elderly.

British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults: accredited by NICE

“…Other drugs, such as benzocaine and tetracaine, have been used, but lidocaine is the best characterised with a low risk of adverse effects (including methaemoglobinaemia)126 Cocaine has previously been used for nasal anaesthesia, but is no longer routinely available in the UK and can be associated with myocardial ischaemia and infarction 127 128…”

An Unusual Complication During Bronchoscopy: Hypotension, Global ST Segment Elevation, and Acute Severe Left Ventricular Systolic Dysfunction

“…2,4-7 Myocardial ischemia and acute ST elevation myocardial infarction following bronchoscopy, although uncommon, have also been reported. 1,8,9 Cardiac ischemia and arrhythmias, although rare, are generally due to elevated circulating catecholamines, precipitation of true myocardial ischemia, or following administration of anesthetic drugs, especially in patients with underlying hypoxemia and other comorbidities. The ECG changes in our patient suggested a massive myocardial infarction, which was corroborated by the elevated cardiac biomarker levels.…”

Cocaine‐induced myocardial infarction

“…Cocaine is cardiotoxic producing coronary artery spasm, angina, myocardial infarction (MI), arrhythmias and sudden cardiac death. These are mediated via (Osula et al , 2003):…”

“…Cocaine is cardiotoxic producing coronary artery spasm, angina, myocardial infarction (MI), arrhyth-mias and sudden cardiac death. These are mediated via (Osula et al, 2003): • increased myocardial oxygen demand resultant from raised systemic blood pressure and heart rate • coronary vasoconstriction caused by a 1 adrenergic properties and calcium-dependent direct vasoconstriction • endothelial dysfunction predisposing vasoconstriction and thrombosis…”