A pilot study to assess the safety of dobutamine stress echocardiography in the emergency department evaluation of cocaine-associated chest pain.
OBJECTIVE
Chest pain in the setting of cocaine use poses a diagnostic dilemma. Dobutamine stress echocardiography (DSE) is a widely available and sensitive test for evaluating cardiac ischemia. Because of the theoretical concern regarding administration of dobutamine in the setting of cocaine use, we conducted a pilot study to assess the safety of DSE in emergency department patients with cocaine-associated chest pain.


METHODS
A prospective case series was conducted in the intensive diagnostic and treatment unit in the ED of an urban tertiary-care teaching hospital. Patients were eligible for DSE if they had used cocaine within 24 hours preceding the onset of chest pain and had a normal ECG and tropinin I level. Patients exhibiting signs of continuing cocaine toxicity were excluded from the study. All patients were admitted to the hospital for serial testing after the DSE testing in the intensive diagnostic and treatment unit.


RESULTS
Twenty-four patients were enrolled. Two patients had inadequate resting images, one DSE was terminated because of inferior hypokinesis, another DSE was terminated because of a rate-related atrial conduction deficit, and 1 patient did not reach the target heart rate. Thus, 19 patients completed a DSE and reached their target heart rates. None of the patients experienced signs of exaggerated adrenergic response, which was defined as a systolic blood pressure of greater than 200 mm Hg or the occurrence of tachydysrhythmias (excluding sinus tachycardia). Further suggesting lack of exaggerated adrenergic response, 13 (65%) of 20 patients required supplemental atropine to reach their target heart rates.


CONCLUSIONS
No exaggerated adrenergic response was detected when dobutamine was administered to patients with cocaine-related chest pain.
Dribben
W H
WH
Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN, USA. dribbenw@msnotes.wustl.edu
Kirk
M A
MA
Trippi
J A
JA
Cordell
W H
WH
D000328:Adult; D002316:Cardiotonic Agents / Q000009:adverse effects; D002637:Chest Pain / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D019970:Cocaine-Related Disorders / Q000150:complications*; D003937:Diagnosis, Differential; D004280:Dobutamine / Q000009:adverse effects; D004452:Echocardiography / Q000379:methods* / Q000592:standards; D004562:Electrocardiography; D004638:Emergency Treatment / Q000379:methods* / Q000592:standards; D005080:Exercise Test / Q000379:methods* / Q000592:standards; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000139:chemically induced* / Q000000981:diagnostic imaging* / Q000503:physiopathology; D010865:Pilot Projects; D011446:Prospective Studies; D012449:Safety; D013566:Sympathomimetics / Q000009:adverse effects; D013610:Tachycardia / Q000139:chemically induced
D002316:Cardiotonic Agents; D013566:Sympathomimetics; D004280:Dobutamine