Frequency of acute coronary syndrome in patients presenting to the emergency department with chest pain after methamphetamine use.
We reviewed the frequency of acute coronary syndrome (ACS) in patients presenting to our emergency department (ED) with chest pain after methamphetamine (MAP) use during a 2-year interval. Thirty-three patients (25 males, 8 females; average age 40.4 +/- 8.0 years) with a total of 36 visits met study inclusion criteria: 1) non-traumatic chest pain, 2) positive MAP urine toxicology screen, 3) admission to "rule-out" myocardial infarction, 4) chest radiograph demonstrating no infiltrates. An ACS was diagnosed in 9 patients (25%). Three patients (8%) (2 ACS and 1 non-ACS) suffered cardiac complications (ventricular fibrillation, ventricular tachycardia, supraventricular tachycardia, respectively). Age, gender, cardiac risk factors, prior coronary artery disease, initial systolic blood pressure and heart rate did not differ significantly in the ACS and non-ACS groups. The initial and subsequent electrocardiograms (EKG) were normal in 1/9 (11%) patients with ACS and 16/27 (59%) without ACS (p < 0.05). Our findings suggest that: 1) ACS is common in patients hospitalized for chest pain after MAP use, and 2) the frequency of other potentially life-threatening cardiac complications is not negligible. A normal EKG lowers the likelihood of ACS, but an abnormal EKG is not helpful in distinguishing patients with or without ACS.
Division of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California 95817, USA.
Samuel D
SD
Turnipseed
John R
JR
Richards
J Douglas
JD
Kirk
Deborah B
DB
Diercks
Ezra A
EA
Amsterdam
D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D019969:Amphetamine-Related Disorders / Q000150:complications*; D001794:Blood Pressure; D002140:California / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000009:adverse effects*; D002637:Chest Pain / Q000139:chemically induced*; D003327:Coronary Disease / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004562:Electrocardiography; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
D000697:Central Nervous System Stimulants; D008694:Methamphetamine