QUIZ 21
A 24 year old male comes to the ER. He has Atrial fibrillation. You start him on IV heparin and PO Warfarin. You find out in the history that he was out with his friends over the weekend and had at least 6 cans of beer. You are convinced that it is due to his drinking that he has had the arrhythmia. You send out his labs and his CPK is elevated.
Q1. You should next ask for which of the following?
This patient has the holiday-heart syndrome. After drinking alcohol heavily (usually after a holiday) the patient typically goes into A-fib or another SVT. Since the CPK is elevated in a person so young, the next step would be an EKG but that is deliberately left out of this question so that you start thinking one step ahead. Iso-enzyme quantification is important to know whether this came from the heart or the muscle or the brain. A Urine drug screen can tell us if the patient had cocaine or not but will not tell us if this caused a seizure or an MI or a stroke. Iso-enzymes will tell us how to next manage the patient (Telemetry or neuro-checks).
Q2. Your tests lead you to find out that he has cocaine in his urine. Which of the following medications is contra-indicated in his case?
Cocaine causes vaso-constriction and this is how it causes stroke or MI. Beta blockers worsen the vasoconstriction and they should thus be avoided in this case.
Cocaine also causes nasal septal perforation as shown in the picture below: