Late coronary aneurysm formation after directional atherectomy

Abstract

Treatment of myocardial infarction associated with amphetamine abuse is not clearly defined at present. Because the possible mechanisms leading to myocardial infarction are coronary spasm and thrombosis, a net benefit from thrombolytic therapy is possible but still uncertain. Thrombolysis has been shown to be effective in treating cocaineassociated myocardial infarction. In that situation, however, thrombosis is present in most patients.7 Calciumchannel blockers, which are effective in treating vasospastic angina, may play a special role in the treatment of amphetamine-related myocardial infarction. Antiplatelet agents may also be helpful. Beta-adrenergic-blocking agents should probably be avoided until the pathophysiology of this condition has been clarified because they may exacerbate vasospasm. Lang et al5 demonstrated decreased coronary blood flow and increased coronary resistance when propranolol was given intracoronarily to patients who were intranasal cocaine users. This case demonstrates a fatal complication of recent amphetamine use. Because of the significant number of adolescents and young adults who have exposure to amphetamines,a physicians caring for this patient population should maintain a high index of suspicion regarding coronary events in this otherwise low-risk population.