A 'sniff' away from death: a case of cocaine-induced coronary artery dissection

The multiple, deleterious cardiovascular effects of cocaine abuse are well known. Recent data have shown that cocaine abuse in the UK remains high with an upward trend over the last few years and a significant associated mortality/morbidity. Cocaine-induced coronary artery dissection (CAD) is one of the rare totally preventable manifestations of cocaine abuse. With this case report, we aim to contribute to the limited number of cocaine-induced CAD described in literature and increase public awareness in an attempt to reverse the upward trend of cocaine abuse.

But he has no chest pain

Atypical presentations of acute coronary syndromes (ACS) are not uncommon and have been associated with higher mortality probably, because these patients are misdiagnosed and undertreated. They are most frequently encountered in older patients, women and in patients with diabetes, chronic renal failure or dementia. It is also well described in the literature that many chemotherapy agents are associated with myocardial ischaemic events. In addition to that, patients with cancer frequently receive large doses of opiate analgesics for chronic pain, which can obscure the symptoms of myocardial ischaemia. In this case report, we describe a patient who was receiving chemotherapy and large doses of opiate analgesics and presented with atypical symptoms for ACS. Our aim is to raise awareness of this challenging group of patients and the necessity to pay particular attention to symptoms other than chest pain as potential indicators of myocardial ischaemia.