UMEM Educational Pearls

Category: Cardiology

Title: cocaine chest pain

Keywords: cocaine, chest pain, myocardial infarction (PubMed Search)

Posted: 6/1/2008 by Amal Mattu, MD (Updated: 6/5/2020)
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Just a few quick pearls about cocaine-chest pain and myocardial infarction:
 

  • 0.7%-6% of patients presenting to the ED with chest pain during or immediately after using cocaine will rule in for an MI based on cardiac biomarkers. The 6% figure is the most commonly-quoted number.
  • The risk of MI rises as much as 24-fold during the first hour after cocaine use. Although the risk decreases significantly after that, cocaine-related vasoconstriction can still cause acute MI hours or as many as 4 days later.
  • Chest pain is not reliably present in patients with cocaine-associated MI, with one study reporting that only 44% of patients with cocaine-associated MI had chest pain (Hollander and Hoffman, J Emerg Med 1992). Dyspnea and diaphoresis are other common symptoms that should prompt concern for acute MI if chest pain is not present.

[McCord J, et al. Management of cocaine-associated chest pain and myocardial infarction. Circulation 2008;117:897-1907.]