Skip to main content
Journal of Medical Toxicology logoLink to Journal of Medical Toxicology
. 2006 Sep;2(3):108–111. doi: 10.1007/BF03161019

Phentolamine therapy for cocaine-associated acute coronary syndrome (CAACS)

Gar Ming Chan 1,, Rahul Sharma 2, Dennis Price 3, Robert S Hoffman 3, Lewis S Nelson 3
PMCID: PMC3550159  PMID: 18072128

Abstract

Introduction

The emergency department (ED) evaluation of cocaine-associated acute coronary syndrome (CAACS) is often a diagnostic and therapeutic challenge.

Case report

We are reporting on the treatment of a patient with cocaine-associated acute coronary syndrome (CAACS) who did not benefit from standard therapy, but who eventually responded positively to phentolamine, an alpha-adrenergic receptor antagonist.

Discussion

This report should encourage physicians to add phentolamine to their pharmacotherapeutic armamentarium in the treatment of CAACS.

Keywords: cocaine, acute coronary syndrome, phentolamine, toxicity

Full Text

The Full Text of this article is available as a PDF (311.3 KB).

References

  • 1.Hollander JE. The management of cocaine-associated myocardial ischemia. N Engl J Med. 1995;333:1267–1272. doi: 10.1056/NEJM199511093331907. [DOI] [PubMed] [Google Scholar]
  • 2.Brody SL, Slovis CM, Wrenn KD. Cocaine-related medical problems: Consecutive series of 233 patients. Am J Med. 1990;88:325–331. doi: 10.1016/0002-9343(90)90484-U. [DOI] [PubMed] [Google Scholar]
  • 3.Hollander JE, Hoffman RS, Gennis P, Fairweather P, Feldman JA, Fish SS, et al. Cocaine-associated chest pain: one-year follow-up. Acad Emerg Med. 1995;2:179–184. doi: 10.1111/j.1553-2712.1995.tb03191.x. [DOI] [PubMed] [Google Scholar]
  • 4.Hollander JE. Cocaine-associated myocardial infarction. J R Soc Med. 1996;89:443–447. [PMC free article] [PubMed] [Google Scholar]
  • 5.Hahn IH, Hoffman RS. Cocaine use and acute myocardial infarction. Emerg Med Clin North Am. 2001;19:493–510. doi: 10.1016/S0733-8627(05)70197-8. [DOI] [PubMed] [Google Scholar]
  • 6.Shesser R, Davis C, Edelstein S. Pneumomediastinum and pneumothorax after inhaling alkaloidal cocaine. Ann Emerg Med. 1981;10:213–215. doi: 10.1016/S0196-0644(81)80166-7. [DOI] [PubMed] [Google Scholar]
  • 7.Adrouny A, Magnusson P. Pneumopericardium from cocaine inhalation. N Engl J Med. 1985;313:48–49. doi: 10.1056/NEJM198507043130113. [DOI] [PubMed] [Google Scholar]
  • 8.Delaney K, Hoffman RS. Pulmonary infarction associated with crack cocaine use in a previously healthy 23-year-old woman. Am J Med. 1991;91:92–94. doi: 10.1016/0002-9343(91)90080-H. [DOI] [PubMed] [Google Scholar]
  • 9.Kugelmass AD, Oda A, Monahan K, Cabral C, Ware JA. Activation of human platelets by cocaine. Circulation. 1993;88:876–883. doi: 10.1161/01.cir.88.3.876. [DOI] [PubMed] [Google Scholar]
  • 10.Flores ED, Lange RA, Cigarroa RG, Hillis LD. Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses. J Am Coll Cardiol. 1990;16:74–79. doi: 10.1016/0735-1097(90)90459-3. [DOI] [PubMed] [Google Scholar]
  • 11.Brogan WC, Lange RA, Kim AS, Moliterno DJ, Hillis LD. Alleviation of cocaine-induced coronary vasoconstriction by nitroglycerin. J Am Coll Cardiol. 1991;18:581–586. doi: 10.1016/0735-1097(91)90617-I. [DOI] [PubMed] [Google Scholar]
  • 12.Guinn MM, Bedford JA, Wilson MC. Antagonism of intravenous cocaine lethality in nonhuman primates. Clin Toxicol. 1980;16:499–508. doi: 10.3109/15563658008989979. [DOI] [PubMed] [Google Scholar]
  • 13.Catravas JD, Waters IW. Acute cocaine intoxication in the conscious dog: Studies on the mechanism of lethality. J Pharmacol Exp Ther. 1981;217:350–356. [PubMed] [Google Scholar]
  • 14.Catravas JD, Waters IW, Walz MA, Davis WM. Acute cocaine intoxication in the conscious dog: Pathophysiologic profile of acute lethality. Arch Int Pharmacodyn Ther. 1978;235:328–340. [PubMed] [Google Scholar]
  • 15.Lange RA, Cigarroa RG, Flores ED, McBride W, Kim AS, Wells PJ, et al. Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Ann Intern Med. 1990;112:897–903. doi: 10.7326/0003-4819-112-12-897. [DOI] [PubMed] [Google Scholar]
  • 16.Lange RA, Cigarroa RG, Yancy CW, Willard JE, Popma JJ, Sills MN, et al. Cocaine-induced coronary-artery vasoconstriction. N Engl J Med. 1989;321:1557–1562. doi: 10.1056/NEJM198912073212301. [DOI] [PubMed] [Google Scholar]
  • 17.Hollander JE, Carter WA, Hoffman RS. Use of phentolamine for cocaine-induced myocardial ischemia. N Engl J Med. 1992;327:361–361. doi: 10.1056/NEJM199207303270517. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Medical Toxicology are provided here courtesy of Springer

RESOURCES