title: Current strategies in the evaluation and management of cocaine-induced chest pain.
abstract: With each successive year, the number of Emergency Department (ED) visits related to illicit drug abuse has progressively increased. Cocaine is the most common illegal drug to cause a visit to the ED. Cocaine use results in a variety of pathophysiological changes with regards to the cardiovascular system, such as constriction of coronary vessels, dysfunction of vascular endothelium, decreased aortic elasticity, hemodynamic disruptions, a hypercoagulable state, and direct toxicity to myocardial and vascular tissue. The clinical course of patients with cocaine-induced chest pain (CCP) is often challenging, and electrocardiographic findings can be potentially misleading in terms of diagnosing a myocardial infarction. In addition, there is no current satisfactory study regarding outcomes of use of various pharmacological drug therapies to manage CCP. At present, calcium-channel blockers and nitroglycerin are two pharmacological agents that are advocated as first-line drugs for CCP management, although the role of labetalol has been controversial and warrants further investigation. We performed an extensive search of available literature through a large number of scholarly articles previously published and listed on Index Medicus. In this review, we put forward a concise summary of the current approach to a patient presenting to the ED with CCP and management of the clinical scenario. The purpose of this review is to summarize the understanding of cocaine's cardiovascular pathophysiology and to examine the current approach for proper evaluation and management of CCP.
authors.affiliation: From the *Department of Medicine, Surat Municipal Institute of Medical Education and Research, Surat, Gujarat, India; †Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY; ‡Department of Internal Medicine, St John Hospital and Medical Center, Wayne State University School of Medicine, Detroit, MI; §Department of Internal Medicine, Presence Saint Joseph Hospital, Chicago, IL; and ¶VA Ann Arbor Health Care System, University of Michigan, Ann Arbor, MI.
authors.forename: Pratik R
authors.initials: PR
authors.lastname: Agrawal
authors.forename: Tiziano M
authors.initials: TM
authors.lastname: Scarabelli
authors.forename: Louis
authors.initials: L
authors.lastname: Saravolatz
authors.forename: Annapoorna
authors.initials: A
authors.lastname: Kini
authors.forename: Abhijay
authors.initials: A
authors.lastname: Jalota
authors.forename: Carol
authors.initials: C
authors.lastname: Chen-Scarabelli
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Halperin
mesh_terms: D054058:Acute Coronary Syndrome / Q000139:chemically induced / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D015415:Biomarkers / Q000097:blood; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002637:Chest Pain / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D003042:Cocaine / Q000009:adverse effects*; D019970:Cocaine-Related Disorders / Q000150:complications*; D018765:Dopamine Uptake Inhibitors / Q000009:adverse effects*; D004562:Electrocardiography; D006801:Humans; D009203:Myocardial Infarction / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D015425:Myocardial Reperfusion / Q000379:methods; D009204:Myocardial Revascularization / Q000379:methods; D011379:Prognosis; D055502:Secondary Prevention; D014057:Tomography, X-Ray Computed
chemical_list: D015415:Biomarkers; D002316:Cardiotonic Agents; D018765:Dopamine Uptake Inhibitors; D003042:Cocaine