- Right MI is preload dependent, avoid nitro and morphine (both decrease preload)
- Early PCI is recommended unless liver or pulmonary failure or cancer, acute chest pain and low likelihood of ACS, patients who will not consent to revascularization. These patient patients should get ASA or clopidogrel or ticagrelor.
Acute cocaine use is associated with arterial vasoconstriction and enhanced thrombus formation and causes tachycardia, hypertension, increased myocardial oxygen demand, and increased vascular shearing forces.
- Patients with cocaine-induced MI get many of the same things that any other patient with MI would get.
- One exception is the use of beta blockers, which are not recommended with recent cocaine use.
- They should get ASA, nitro and can add calcium channel blockers if the ischemia is not relieved.
- Benzodiazepines are used, sometimes in large doses, to control blood pressure and heart rate and produce sedation.
- Pheochromocytoma is not an MI, it is an adrenal tumor, but it can mimic an MI (hypertension, headache, chest pain, palpations, sweating, flushing, shortness of breath).
- This would be a tricky one to test over. It’s often missed even in the real world. Patients are often misdiagnosed before being diagnosed with a CT after repeated episodes of hypertensive urgency and still no resolutions of symptoms, sometimes even after stenting.
- The only cure is to remove the tumor.
- Treat 10-14 days before surgery with phenoxybenzamine 10-20 mg BID, nicardipine or clevidipine then a CCB, terazosin or doxazosin and a beta blocker.