76 y M p/w chest pain after using cocaine. EKG is below. What medications should be avoided in this patient?


This EKG demonstrates sinus bradycardia with ST elevation in leads II, III, aVf, v3, v4, v5 and v6, suggesting inferior wall MI. Inferior MI should prompt a right sided EKG to look for right sided MI. This patient was found to have 3 vessel disease on cath, with an RCA stent placed.

Nitrates should be avoided in right-sided MI because they can decrease preload and worsen hemodynamics. Beta blockers should be avoided in patients abusing cocaine as they may cause unopposed alpha activity.

Source: Uptodate, Goldfranks Toxicologic Emergencies