Cocaine-associated chest pain

Background

Cocaine is a catalyst for CAD & up to 6% of cocaine related CP develop an MI, however, a 9-12 hour period of ECG's and serial troponins can be safe. Of the 334 pts studied, if both were negative, no deaths from CV events occurred at 30 days. 4 pts did have non-fatal MI's but were using coc at the time (NEJM 2/03).

Epidemiology

1. causes vasculitis
2. 6% incidence of AMI w/ cocaine CP
3. Cocaine assoc c 24x risk of MI

Workup

nl CP w/o (see disposition)

Diagnosis

1. 1- 3hrs onset from last use
   1. if >3 hrs = lower risk of MI
2. Most with characterislnic pain
3. Dyspnea, diaploresis, and nausea
4. Most have nl vitals

DDx

Chest Pain (DDx)

Treatment

1. Benzos
2. Labetalol?
   1. Theoretical contra-indication B-blocker 2nd to unopposed alpha

Disposition

1. May discharge after: 9-12 hour period of ECG's and serial troponins, if both are negative.
   1. NEJM 2/03; n=334; outcome of zero events at 30dys if no more cocaine

Risk Stratification

1. Lower:
   1. also low risk if ecg normal and without ischemic changes
   2. cocaine can however cause AMI, dilated cardiomyopathy,/ chf

See Also

Cocaine Withdrawl

Source

10/07 DONALDSON (adapted from Lampe, Mistry)