Acute Coronary Syndrome Secondary to Intraoperative Cocaine Use: A Case Study

<p><strong>Abstract</strong></p>\n<p><strong>Background</strong></p>\n<p>Topical cocaine remains a common choice in ENT surgeries despite known cardiovascular risks, including myocardial infarction (MI). We present a case of acute coronary syndrome following intraoperative cocaine use during a functional endoscopic sinus surgery (FESS).</p>\n<p><strong>Case Presentation</strong></p>\n<p>A 55-year-old female, with no significant medical history, underwent FESS under general anesthesia. Shortly after the cocaine administration, she developed a profound cardiovascular collapse, necessitating resuscitative measures. Diagnostic workup revealed ST-segment changes, elevated troponin levels, and severe left ventricular dysfunction consistent with stress cardiomyopathy. Subsequent imaging showed no coronary artery disease, supporting the diagnosis of cocaine-induced MI.</p>\n<p><strong>Discussion</strong></p>\n<p>Cocaine's sympathomimetic effects precipitate MI by increasing myocardial oxygen demand and causing coronary vasoconstriction. Genetic variations affecting cocaine metabolism may influence individual susceptibility to toxicity. Despite guidelines, adverse reactions can occur unpredictably, necessitating vigilance and personalized risk assessment.</p>\n<p><strong>Conclusion</strong></p>\n<p>This case highlights the serious cardiac risks associated with medical cocaine use and underscores the need for careful patient selection, monitoring, and consideration of alternative agents in sinonasal surgeries. Genetic screening for metabolic variants may aid in optimizing safety. Further research is crucial to refine protocols and enhance safety in cocaine use for medical purposes.</p>\n<p><strong>Keywords:</strong> Cocaine, myocardial infarction, stress cardiomyopathy, functional endoscopic sinus surgery, genetic variability, personalized medicine.</p>