Aborted sudden death, transient Brugada pattern, and wide QRS dysrrhythmias after massive cocaine ingestion
by
Ortega-Carnicer J, Bertos-Polo J, Gutierrez-Tirado C.
Intensive Care Unit and Emergency Service,
Hospital Alarcos, Los Alisos 10,
13002-Ciudad Real, Spain.
JORTEGACAR@NEXO.ES
J Electrocardiol. 2001 Oct;34(4):345-9


ABSTRACT

Although cocaine is one of the leading causes of drug-related deaths, there is little clinical information describing the precise sequence of events leading to death in the cocaine intoxication. Usually, cocaine-related sudden deaths are unwitnessed, its electrocardiographic features are not attainable, and the majority of these patients have a rapidly fatal course and die before arriving at the hospital. We report a patient with massive cocaine ingestion who developed psychomotor agitation and generalized seizures followed by asystolic cardiac arrest. Ventilation with supplemental oxygen by endotracheal intubation immediately restored spontaneous heart beat. After resuscitation, a severe metabolic acidosis (pH 6.65) and cardiac dysrrhythmias consistent with sodium channel poisoning were detected. The electrocardiogram showed accelerated junctional rhythm at 85 beats/min with right bundle branch block and left anterior hemiblock configuration, prolongation of QRS (0.16 sec) and QTc (0.52 sec) intervals, and terminal J wave associated with coved ST-segment elevation in leads V(1) and V(2) resembling the Brugada syndrome. Sodium bicarbonate administration was quickly followed by normalization of the cardiac conduction disturbances. This article discusses the clinical and electrophysiologic implications of these findings.


History
Inca tea
Oral cocaine
The coke-craving brain
Cocaine and depression
Cocaine and the lonely rat
Cocaine use and heart problems
Cocaine use and cardiac complications

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