A 30-year-old man presents to the emergency department with severe retrosternal chest pain, ECG showing ST elevation in V1 to V3, blood pressure 150/100 mmHg, and dilated pupils. He admits to snorting cocaine an hour earlier. Which drug is CONTRAINDICATED in his management?
- A Aspirin
- B Benzodiazepines
- C Propranolol ✓
- D Nitrates
Correct answer: C. Propranolol
Explanation
Beta-blockers are contraindicated in cocaine-associated myocardial infarction because blocking beta-2 mediated vasodilatation leaves unopposed alpha-mediated coronary and peripheral vasoconstriction, worsening ischaemia and hypertension. Benzodiazepines are the first-line therapy as they reduce sympathetic drive, while aspirin and nitrates are safe adjuncts. Coronary spasm plus thrombosis underlies the infarction in these patients.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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