Acute myocardial infarction and chest pain syndromes after cocaine use

https://doi.org/10.1016/0002-9149(90)90529-AGet rights and content

Abstract

Seventy patients hospitalized with chest pain after cocaine use were retrospectively evaluated to define the risk and clinical course of acute myocardial infarction (AMI). AMI developed in 22 patients (31%) and transient myocardial ischemia was seen in an additional 9 patients (13%). Coronary risk factors did not distinguish those who developed AMI from those who did not. The presenting electrocardiogram was abnormal in 20 of 22 patients who evolved AMI and in 19 of 48 of those who did not. Creatine kinase levels were elevated in 75% of the patients, including 65% of those who did not develop AMI, but creatine kinase-MB elevations were only observed in the AMI group. The route of cocaine administration did not predict AMI and there was no predilection for a particular coronary vascular bed. The length of time between drug use and onset of AMI pain was often quite prolonged (median interval, 18 vs 1 hour in the non-AMI group). Eight of the patients with AMI underwent cardiac catheterization and 4 had significant coronary narrowing.

References (30)

  • HT Dodge et al.

    Quantitative contrast angiography for assessment of ventricular performance in heart disease

    J Am Coll Cardiol

    (1983)
  • R Rubin et al.

    Cocaine induced rhabdomyolysis masquerading as a myocardial infarction

    Am J Med

    (1989)
  • DM Barnes

    Drugs: running the numbers

    Science

    (1988)
  • L Gould et al.

    Cocaine induced myocardial infarction

    NY State J Med

    (1985)
  • JD Haines et al.

    Acute myocardial infarction associated with cocaine abuse

    South Med J

    (1987)
  • Cited by (108)

    • Acute Cardiovascular Toxicity of Cocaine

      2022, Canadian Journal of Cardiology
      Citation Excerpt :

      A post hoc analysis of that research included adding one point to the risk factors component for use of cocaine and considering the history as moderately suspicious, which yielded a sensitivity and negative predictive value close to 100%, with the acknowledgement, however, that this could lead to overtriaging of these patients.83 In patients presenting with cocaine-associated chest pain, up to 84% have been reported to have “abnormal” ECGs on presentation.52,58,68 Many of the abnormal ECGs in these often young patients are related to normal variants, including J-point and ST-segment elevations due to early repolarisation.84

    • Overdose of cardiotoxic drugs

      2018, Cardiac Intensive Care
    • Drugs of Abuse and Cardiotoxicity

      2018, Comprehensive Toxicology: Third Edition
    View all citing articles on Scopus
    View full text