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Chest pain after cocaine use is a common emergency department presenting complaint. Conventional wisdom, supported by some evidence, has dictated that patients with cocaine-associated chest pain should not receive β-blockers, unlike the recommendation for β-blockers in cardiac chest-pain patients without cocaine exposure. Although a strong body of evidence supports β-blockade for patients with myocardial infarction, the theory regarding patients with cocaine exposure is that β-blockade would lead to unopposed α stimulation and exacerbate the untoward cardiac effects of cocaine (which include myocardial depression and vasospasm) and would negate potential positive effects of treatment of MI and systolic dysfunction.
In a retrospective cohort …