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


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


==Workup==
==Workup==
 
nl CP w/o (see disposition)
 
= nl CP w/o (see disposition)
 


==Treatment==
==Treatment==
 
#Benzos
 
#Labetalol?
1) Benzos
##Theoretical contra-indication B-blocker 2nd to unopposed alpha
 
2) Labetalol?
 
*Theoretical contra-indication B-blocker 2nd to unopposed alpha
 


==Disposition==
==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
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===
===Risk Stratification===
 
#Lower:
 
##also low risk if ecg normal and without ischemic changes
Lower:
##cocaine can however cause AMI, dilated cardiomyopathy,/ chf
 
- also low risk if ecg normal and without ischemic changes
 
- cocaine can however cause AMI, dilated cardiomyopathy,/ chf
 


==Source ==
==Source ==
10/07 DONALDSON (adapted from Lampe, Mistry)
10/07 DONALDSON (adapted from Lampe, Mistry)


[[Category:Cards]]
[[Category:Cards]]
[[Category:Tox]]

Revision as of 16:39, 12 March 2011

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

Source

10/07 DONALDSON (adapted from Lampe, Mistry)

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