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

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

Workup

nl CP w/o (see disposition)

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)