Document Detail

High serum tryptase value in massive acute myocardial infarction with ventricular arrhythmia exortion in a cocaine abuser.
MedLine Citation:
PMID:  19505405     Owner:  NLM     Status:  MEDLINE    
A 38-year-old cocaine abuser was admitted to the Emergency Department with a one hour history of precordial chest pain associated with shortness of breath and extreme discomfort. On admission his blood pressure was 90/60 mmHg, the resting 12-lead ECG showed ventricular tachycardia at about 300 beats per minute, and oxygen saturation was 86 percent in room air. After electrical cardioversion, the 12-lead ECG revealed sinusal rhythm and a significative ST segment elevation in leads I, aVL and V1-V6, that was about 0.5 mV in leads I and aVL and more than 1 mV in leads V2, V3 and V4. Laboratory determinations showed elevated creatine-chinase MB (CK-MB) and troponin I. An emergency coronary angiogram was normal. Cocaine use is a major cause of acute myocardial infarction in patients with normal epicardial coronary arteries but the exact mechanism still remains unclear. We hypothesize a non-IgE mediated mast-cell activation, with a direct action played by cocaine, and consequent massive expression of several factors effecting the microcirculatory system, including pro-inflammatory cytokines and chemokines. Our hypothesis is supported by an elevated serum tryptase levels in the patient.
C Caroselli; P Perfetti; G Bruno
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Publication Detail:
Type:  Case Reports; Letter    
Journal Detail:
Title:  International journal of immunopathology and pharmacology     Volume:  22     ISSN:  0394-6320     ISO Abbreviation:  Int J Immunopathol Pharmacol     Publication Date:    2009 Apr-Jun
Date Detail:
Created Date:  2009-06-09     Completed Date:  2009-07-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8911335     Medline TA:  Int J Immunopathol Pharmacol     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  525-9     Citation Subset:  IM    
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MeSH Terms
Biological Markers / blood
Cocaine-Related Disorders / complications*,  enzymology,  immunology
Creatine Kinase, MB Form / blood
Mast Cells / enzymology*
Myocardial Infarction / enzymology,  etiology*,  immunology
Tachycardia, Ventricular / enzymology,  etiology*,  immunology
Troponin I / blood
Tryptases / blood*
Reg. No./Substance:
0/Biological Markers; 0/Troponin I; EC Kinase, MB Form; EC

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