A 28-year-old man presents to the emergency department with chest pain shortly after using crack cocaine. He is agitated, BP is 160/100 mmHg, HR is 112/min, and ECG shows no ST elevation. Which component of management is correct?

• A Administer propranolol intravenously to control tachycardia and hypertension
• B Start aspirin, ticagrelor and heparin immediately as for NSTEMI
• C Give benzodiazepines first, then nitrates; avoid beta blockade initially ✓
• D Perform urgent coronary angiography within 2 hours

Explanation

Cocaine causes coronary vasospasm and increased oxygen demand. Benzodiazepines reduce sympathetic tone and often relieve both pain and hypertension; nitrates treat ongoing spasm. Nonselective beta blockers are avoided because unopposed alpha stimulation can worsen vasospasm and hypertension. Antiplatelet and heparin therapy is reserved for confirmed MI, and routine early angiography is not mandated in the absence of high-risk features or ST elevation.

Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.

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Written and medically reviewed by the StethoPrep medical team.