A Patient with Cocaine Chest Pain and Prehospital Computer interpretation of ***STEMI***

A 20-something male drank heavily of ethanol and used cocaine, then was involved in a stressful verbal altercation, at which time he developed chest pain.911 was called and the medics recorded this ECG (unfortunately, leads V4-V6 are missing)Due to marked ST Elevation, the computer read was ***STEMI***What do you think?He arrived in the ED and had this ECG recorded:Very similar to the prehospital ECG.The Mortara (Veritas algorithm) Interpretation was:p.p1 {margin: 0.1px 0.0px 0.1px 1.0px; font: 9.0px Arial}MARKED ST ELEVATION, CONSIDER SEPTAL INJURY ***ACUTE MI***What do you think?The ECG shows Brugada morphology in V1 and V2, and the typical normal variant ST elevation in lead V3.Brugada morphology can be caused by baseline Brugada morphology, including Brugada syndrome, or by hyperkalemia or Sodium channel blockade.Cocaine not only has effects on dopamine neurotransmission, but is also a sodium channel blocker, as are all " -caine " local anesthetics. Cocaine is well known to result in Brugada morphology.See this post and associated case reports:Cardiac arrest, severe acidosis, and a bizarre ECGThe patient was admitted and ruled out for acute MI by serial troponins.Below are subsequent ECGs, showing resolution of the Brugada morphology as the cocaine metabolizes. Cocaine metabolism is rapid. Afterapproximately 3-4 hours, the cocaine and its effect are gone. Testing for cocaine is for the inactive metaboliteBenzoylecgonine, and this inactive metaboli...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs