EL SERVIER DOYMA

Revista Colombiana de Cardiología (Colombian Magazine of Cardiology)

www.elservier.es/revcolcar

Adult Cardiology – Case Studies

Heroin-induced myocardial infarction

Beatriz Willsª, Andrés F. Buitragoªb*, Nohra P. Romeroªb y Mariana Sotoª

ª Department of Critical Care Medicine and Intensive Care, University Hospital Fundación (Foundation) Santa Fe de Bogotá, Bogotá, Colombia

b Department of Internal Medicine, Section of Cardiology, University Hospital Fundación (Foundation) Santa Fe de Bogotá, Bogotá, Colombia

Received September 17, 2013; accepted March 10, 2014

Available online on September 24, 2014

…Due to signs of opioid intoxication and the imminence of respiratory failure, airway support and naloxone treatment were initiated. During emergency care, the patient indicated localized precordial pain, of modern intensity, without dysautonomia or dyspnea. Given the possibility of acute coronary syndrome, troponin I was requested, with an initial result of 0.48 ng / mL (reference value: 0-0.3 ng / ml). The initial electrocardiogram showed an ST irregularity in the anterolateral side (fig. 2). An echocardiogram revealed no abnormalities. Given the clinical and biochemical findings, acute myocardial infarction with ST elevation type 2 Killip-Kimball 1 was diagnosed. Vasodilator care was initiated with low-dose intravenous nitroglycerin at low doses, dual antiplatelet therapy (clopidogrel and aspirin) and full anticoagulation with low molecular weight heparin.