Key result
A 42-year-old male presented with an extensive anterior STEMI without significant coronary obstruction, with clinical reasoning suggesting recent cocaine use as the most likely etiology.
Case Report (n=1)
No
In a young patient with multiple potential causes for STEMI, probabilistic clinical reasoning suggests cocaine-induced ischemia as the most likely etiology despite the presence of a left atrial myxoma and normal coronary angiography.
Answers are grounded in this paper and cite their sources.
Alerts clinicians to cocaine in young STEMI without obstruction; leaves association hypothesis-generating pending confirmation.
The differential diagnosis of myocardial infarction in patients with a number of potential causes can be challenging, especially when there is no angiographic evidence of coronary obstruction. We describe a case of extensive anterior ST-elevation myocardial infarction in a young male smoker who had a left atrial myxoma and a history of cocaine use 10 hours before the event. Clinical reasoning during a myocardial infarction investigation should be oriented by the probability of the causal relationship between the ischemic event and each factor present in the clinical context.
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Santos et al. (2018) conducted a case report in ST-elevation myocardial infarction (n=1). Cocaine use and left atrial myxoma was evaluated. A 42-year-old male presented with an extensive anterior STEMI without significant coronary obstruction, with clinical reasoning suggesting recent cocaine use as the most likely etiology.
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