title: Complications from the use of thrombolytic agents in patients with cocaine associated chest pain.
abstract: Previous investigators have noted that patients with cocaine associated chest pain frequently have abnormal electrocardiograms, including ST segment elevation, in the absence of ongoing myocardial ischemia. The effects of these nonischemic ST segment elevations have not been evaluated. We report two patients with cocaine associated chest pain and ST segment elevations who received thrombolytic agents in the absence of myocardial ischemia. Neither patient sustained a myocardial infarction, nor had clinical evidence of reperfusion. The ST segment elevations persisted after resolution of chest pain in both patients, and both of the patients experienced complications of thrombolytic therapy. One patient sustained a hemorrhagic stroke and one had minor oral-pharyngeal bleeding. Given the lack of documented efficacy, concerns about safety, and poor specificity of the electrocardiogram for myocardial ischemia in patients with cocaine associated chest pain, thrombolytic therapy should be used with caution in these patients.
authors.affiliation: Department of Emergency Medicine, University Medical Center, Stony Brook, New York 11794-8350, USA.
authors.forename: J E
authors.initials: JE
authors.lastname: Hollander
authors.forename: L D
authors.initials: LD
authors.lastname: Wilson
authors.forename: P J
authors.initials: PJ
authors.lastname: Leo
authors.forename: R D
authors.initials: RD
authors.lastname: Shih
mesh_terms: D000328:Adult; D002543:Cerebral Hemorrhage / Q000139:chemically induced; D002637:Chest Pain / Q000139:chemically induced*; D003042:Cocaine / Q000009:adverse effects*; D004562:Electrocardiography; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000175:diagnosis / Q000188:drug therapy; D009294:Narcotics / Q000009:adverse effects*; D010960:Plasminogen Activators / Q000009:adverse effects*; D010959:Tissue Plasminogen Activator / Q000009:adverse effects*
chemical_list: D009294:Narcotics; D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator; D003042:Cocaine