Cocaine and Chest Pain: Clinical Features and Outcome of Patients Hospitalized to Rule Out Myocardial Infarction

Abstract

The quality of acute chest pain related to cocaine use is indistinguishable from that experienced in acute myocardial ischemia. Abnormal or normal variant electrocardiographic findings are common in patients with chest pain related to cocaine use, but nevertheless the incidence of acute myocardial infarction is low. The ST-segment and T-wave changes can mimic acute myocardial injury and are most likely normal findings in young black men that can be readily recognized in the emergency department. Most of these patients do not require admission to an intensive care unit.

Utility of Troponin I in Patients with Cocaine-associated Chest Pain

“…2,6,7,19,28 Evidence of myocardial necrosis was higher in the current study than in these studies. In our study, low-risk patients were evaluated in the ED and discharged after negative rest perfusion imaging, while intermediate-risk and highrisk patients were admitted for further evaluation.…”

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

“…44 Gitter and colleagues 54 reported an early repolarization pattern in 32% of patients with cocaine-associated chest pain, a left ventricular hypertrophy pattern in 16%, and a normal ECG in only 32% of patients. Overall, 42% of patients in their cohort of 101 patients manifested electrocardiographic ST-segment elevation, although all of them eventually had MI excluded by cardiac marker testing.…”

“…Overall, 42% of patients in their cohort of 101 patients manifested electrocardiographic ST-segment elevation, although all of them eventually had MI excluded by cardiac marker testing. 54 In the COCHPA study, the sensitivity of an ECG revealing ischemia or MI to predict a true MI was only 36%. 19 The specificity, positive predictive value, and negative predictive value of the ECG were 89.9%, 17.9%, and 95.8%, respectively.…”

“…54,55 In one study, total creatine kinase elevation occurred in 75% of patients, including 65% without MI. 45 Cardiac troponins are the most sensitive and specific markers for the diagnosis of cocaine-associated MI 55 ; therefore, their use is preferred in patients with possible ACS in the setting of cocaine use.…”

Cocaine-Induced Acute Myocardial Infarction

“…Those at low to intermediate risk may be observed in the department before a final plan of disposition is made. In a study by Gitter et al 38 of 101 cocaine patients admitted with chest pain, 18% of patients simply had pleuritic noncardiac chest pain. While admitting electrocardiograms often showed ST or T wave abnormalities, the abnormalities were nonspecific and were mostly related to hypertensive heart disease or early repolarization.…”