Cardiovascular Toxicity of Cocaine of Iatrogenic Origin. Case Report

The use of cocaine as an illicit drug is associated with various cardiovascular events. In recent decades, because of growing levels of consumption, there has been an increasing incidence of these complications. At the same time, cocaine is also widely used as a local anesthetic, mainly in nasal surgery. Its application in this context is controversial due to the potential associated adverse effects. The authors report the case of a 29-year-old patient, with no known cardiovascular risk factors, admitted for elective nasal surgery, under general anesthesia combined with topical application of cocaine. During surgery the patient developed hemodynamic instability in the context of ventricular arrhythmias, after which she presented evolving electrocardiographic changes and increased levels of myocardial necrosis markers, diagnostic of non-ST-segment elevation acute coronary syndrome. The authors review the cardiovascular complications associated with cocaine use and the underlying pathophysiologic mechanisms and discuss the role of cocaine as a topical anesthetic.