Chasing the High, Losing the Beat: A Case of Cocaine-Induced Myocardial Infarction

Cocaine use is a well-established risk factor for various cardiovascular complications, including acute myocardial infarction (MI). The pathophysiological mechanisms responsible for cocaine-induced MI are multifactorial, encompassing coronary vasoconstriction, increased myocardial oxygen demand, and thrombosis. While cocaine-related cardiovascular events are more commonly seen in individuals with pre-existing risk factors, cases involving young, otherwise healthy individuals remain rare, yet they present a significant concern. We present the case of a young male in his late teens who presented to the emergency department with acute-onset chest pain that began two hours following his first-time use of cocaine. On evaluation, it was an anterior wall MI. Urgent coronary angiography was performed, which showed an ostial cut-off in the left anterior descending artery, along with a Thrombolysis in Myocardial Infarction (TIMI) grade V thrombus. Percutaneous coronary intervention (PCI) was successfully performed, and TIMI III flow was achieved. He was discharged on day five post-procedure, and at a six-month follow-up, he was doing well. This case highlights the need for early recognition and prompt intervention, including coronary angiography and PCI, to improve outcomes. Furthermore, it emphasizes the potential for long-term success with proper follow-up care and adherence to prescribed therapies.