Cocaine-associated ACS — EECC MCQ

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EasyCoronary Artery DiseaseCocaine-associated ACSEECC

A 48-year-old man presents to the emergency department with central chest pain after using cocaine 2 hours ago. His ECG shows ST elevation in leads II, III, and aVF. Troponin is elevated. He is hypertensive (185/110 mmHg) and tachycardic (HR 120 bpm). Which of the following medications is contraindicated?

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Correct answer: E — Metoprolol

Beta-blockers are contraindicated in cocaine-associated acute coronary syndromes because they lead to unopposed alpha-adrenergic stimulation, which can worsen coronary vasospasm and hypertension. The recommended approach includes benzodiazepines (to reduce sympathetic drive), GTN/nitrates (for vasospasm), aspirin, and calcium channel blockers (verapamil or diltiazem) if vasospasm persists. If STEMI criteria are met with ongoing symptoms, primary PCI should be performed. Phentolamine (alpha-blocker) may be used for refractory hypertension.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cardiovascular-conditions