Multiple mechanisms of cocaine-induced Brugada electrocardiogram pattern

Cocaine is the most commonly used illicit drug with life-threatening cardiovascular complications, including coronary syndrome, sudden cardiac death, hypertensive crisis, aortic dissection, and stroke. Brugada pattern is a known complication of cocaine intoxication. There are, however, multiple mechanisms that can precipitate the Brugada pattern, beyond the sodium channel-blocking effect of cocaine. The various modes by which cocaine can cause Brugada pattern are discussed. Our patient presented with Brugada pattern and coronary vasospasm, both of which completely resolved with nitroglycerin. This case confirms that vasospasm of the right coronary artery can present as Brugada pattern. The following core competencies are addressed in this article: Medical knowledge, patient care.