title: Cocaine and chest pain: clinical features and outcome of patients hospitalized to rule out myocardial infarction.
abstract: OBJECTIVE
  To investigate the clinical features, electrocardiographic findings, and hospital course in patients admitted with acute chest pain temporally related to cocaine use.
  
  
  METHODS
  Retrospective data analysis.
  
  
  METHODS
  A 485-bed county hospital.
  
  
  METHODS
  One hundred and one consecutive patients with cocaine-related chest pain admitted to the hospital to rule out myocardial infarction.
  
  
  RESULTS
  The quality of the chest pain frequently suggested myocardial ischemia. Dyspnea was common (56%). The onset of chest pain occurred during cocaine use in 21% of patients, within 1 hour of use in 37%, and after 1 hour of use in 42%. Admission electrocardiographic findings were interpreted as normal in 32% of patients; as acute myocardial injury in 8%; as early repolarization variant in 32%; as left ventricular hypertrophy in 16%; and as "other" in 12%. Forty-three percent of patients had ST-segment elevation meeting the electrocardiographic criteria for use of thrombolytic therapy, but such elevation was usually due to the early repolarization variant. The initial total creatine kinase was elevated more than 3.3 mu kat/L (200 U/L) in 43% of patients, and an elevated total creatine kinase was recorded at some time during the hospital course in 47% of patients. The creatine kinase MB fraction was less than 0.02 in all patients. Myocardial infarction was ruled out in all patients. No patient experienced in-hospital cardiovascular complications.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Hennepin County Medical Center, Minneapolis, Minnesota.
authors.forename: M J
authors.initials: MJ
authors.lastname: Gitter
authors.forename: S R
authors.initials: SR
authors.lastname: Goldsmith
authors.forename: D N
authors.initials: DN
authors.lastname: Dunbar
authors.forename: S W
authors.initials: SW
authors.lastname: Sharkey
mesh_terms: D000293:Adolescent; D000328:Adult; D002637:Chest Pain / Q000209:etiology*; D004796:Clinical Enzyme Tests; D003042:Cocaine / Q000009:adverse effects*; D003365:Costs and Cost Analysis; D003402:Creatine Kinase / Q000097:blood*; D003937:Diagnosis, Differential; D004562:Electrocardiography; D005260:Female; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology; D012189:Retrospective Studies; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D003402:Creatine Kinase; D003042:Cocaine