Cocaine-associated chest pain: Difference between revisions
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== Background == | == 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). | 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 === | === Epidemiology === | ||
#causes vasculitis | #causes vasculitis | ||
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#Cocaine assoc c 24x risk of MI | #Cocaine assoc c 24x risk of MI | ||
== Workup == | == Workup == | ||
nl CP w/o (see disposition) | nl CP w/o (see disposition) | ||
== Diagnosis == | == Diagnosis == | ||
#1- 3hrs onset from last use | #1- 3hrs onset from last use | ||
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#Most have nl vitals | #Most have nl vitals | ||
== DDx == | == DDx == | ||
[[Chest Pain (DDx)]] | [[Chest Pain (DDx)]] | ||
== Treatment == | == Treatment == | ||
#ASA, NTG, O2 | #ASA, NTG, O2 | ||
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##Reverses cocaine induced QRS prolongation by Na channel blockade | ##Reverses cocaine induced QRS prolongation by Na channel blockade | ||
== Disposition == | == Disposition == | ||
#May discharge after: 9-12 hour period of ECG's and serial troponins, if both are negative. | #May discharge after: 9-12 hour period of ECG's and serial troponins, if both are negative. | ||
##NEJM 2/03; n=334; outcome of zero events at 30dys if no more cocaine | ##NEJM 2/03; n=334; outcome of zero events at 30dys if no more cocaine | ||
=== Risk Stratification === | === Risk Stratification === | ||
#Lower: | #Lower: | ||
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##cocaine can however cause AMI, dilated cardiomyopathy,/ chf | ##cocaine can however cause AMI, dilated cardiomyopathy,/ chf | ||
== See Also == | == See Also == | ||
*[[Cocaine Withdrawal]] | *[[Cocaine Withdrawal]] | ||
*[[Acute Coronary Syndrome (Main)]] | *[[Acute Coronary Syndrome (Main)]] | ||
== Source == | == Source == | ||
10/07 DONALDSON (adapted from Lampe, Mistry) 7/12 N Engl J Med. 1995 Nov 9;333(19):1267-72. (adapted from Colorado compendium) | 10/07 DONALDSON (adapted from Lampe, Mistry) | ||
7/12 N Engl J Med. 1995 Nov 9;333(19):1267-72. (adapted from Colorado compendium) | |||
[[Category:Cards]] [[Category:Tox]] | [[Category:Cards]] [[Category:Tox]] | ||
Revision as of 19:43, 20 July 2012
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
- causes vasculitis
- 6% incidence of AMI w/ cocaine CP
- Cocaine assoc c 24x risk of MI
Workup
nl CP w/o (see disposition)
Diagnosis
- 1- 3hrs onset from last use
- if >3 hrs = lower risk of MI
- Most with characterislnic pain
- Dyspnea, diaploresis, and nausea
- Most have nl vitals
DDx
Treatment
- ASA, NTG, O2
- Benzos
- Consider Phentolamine or CCB (in benzo non responders)
- Labetalol?
- Theoretical contra-indication B-blocker 2nd to unopposed alpha
- Consider NaHOC3 for Ventricular Arrythmias immediately following cocaine use
- Reverses cocaine induced QRS prolongation by Na channel blockade
Disposition
- May discharge after: 9-12 hour period of ECG's and serial troponins, if both are negative.
- NEJM 2/03; n=334; outcome of zero events at 30dys if no more cocaine
Risk Stratification
- Lower:
- also low risk if ecg normal and without ischemic changes
- cocaine can however cause AMI, dilated cardiomyopathy,/ chf
See Also
Source
10/07 DONALDSON (adapted from Lampe, Mistry)
7/12 N Engl J Med. 1995 Nov 9;333(19):1267-72. (adapted from Colorado compendium)