Case history
Case history #1
A 28-year-old man presents to an emergency department with anxiety, complaining of a racing pulse and chest pain. He reports a history of 10 pack-years of cigarette smoking. He has snorted cocaine intermittently in the past and recently begun smoking crack cocaine. His symptoms clear during observation, after reassurance and mild sedation. Prior to discharge he is referred for drug counselling.
Case history #2
A 32-year-old man presents to his primary care practitioner complaining of depression. He has snorted cocaine for 10 years and his use has increased over time both in amount and frequency. He has tried to stop but has been unable to without support and he recently lost his job. A urine screen is positive for the cocaine metabolite, benzoylecgonine. The patient agrees to participate in a drug treatment programme.
Other presentations
Acute myocardial infarction may occur in people with cocaine use disorder who have underlying myocardial pathology and/or coronary artery disease; patients may present to the emergency department complaining of crushing left chest pain. ECG may show ST changes indicative of acute myocardial infarction. Cataclysmic cardiac events (such as dissection of the left main coronary artery) may occur leading to morbidity and, less commonly, death. Additional, life-threatening complications (e.g., cerebrovascular event or seizure) are also potential consequences of cocaine use. Cocaine contaminated with levamisole has been reported to cause agranulocytosis and ear necrosis, and may also cause internal bleeding.[3][4]
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