Cardiac arrhythmia and myocardial ischaemia related to cocaine and alcohol consumption

Following the drinking of 150 g of alcohol and a large amount of intra-nasal cocaine a previously healthy 31 year old man developed severe retrosternal pain and circulatory failure. An electrocardiogram showed supra-ventricular tachycardia with widespread ischaemic changes. Following electrical cardioversion electrocardiographic evidence of myocardial ischaemia persisted for 1 h. Two days later basal and exercise electrocardiograms were normal. The combination of alcohol and cocaine may be life threatening.