Guidelines: MI and Chest Pain Associated with Cocaine Use

Background and Purpose: During the last decade, cocaine-related visits to emergency departments have increased markedly, and chest pain is present in 40% of such visitors. Cocaine can cause myocardial ischemia via diverse mechanisms — including increased chronotropy and inotropy, coronary vasospasm, prothrombotic state, and accelerated atherosclerosis — and, in some individuals, can actually cause MI. In general, the symptoms, signs, and diagnostic workup in patients with cocaine-associated MI are similar to those in patients with MI unrelated to cocaine. However, treatment of cocaine-triggered ischemia and infarct differs in several ways.

Key Points:

1. Benzodiazepines should be given ver…