Cocaine-associated chest pain
Revision as of 21:24, 18 July 2011 by Rossdonaldson1 (talk | contribs)
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
- Benzos
- Labetalol?
- Theoretical contra-indication B-blocker 2nd to unopposed alpha
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)