Cocaine-associated chest pain
Revision as of 11:25, 20 June 2015 by Neil.m.young (talk | contribs) (Neil.m.young moved page Cocaine Chest Pain to Cocaine 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
- Causes vasculitis
- 6% incidence of AMI w/ cocaine CP
- Cocaine assoc c 24x risk of MI
Clinical Features
- Chest pain in the setting of cocaine or related stimulant use
DDx
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
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)