“Abnormal” electrocardiograms in patients with cocaine-associated chest pain are due to “normal” variants

Hollander, Judd E.; Lozano, Michael; Fairweather, Phillip; Goldstein, Evan V.; Gennis, Paul; Brogan, Gerard X.; Cooling, David S; Thode, Henry C.; Gallagher, E. John

doi:10.1016/0736-4679(94)90699-8

Cited by 72 publications

(27 citation statements)

References 34 publications

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“…In another study of 130 patients with cocaine-associated MI, there was equal distribution between anterior (45%) and inferior (44%) MI, and most were non-Q wave (61%). 40 Cocaine-associated chest pain may be caused by not only MI but also by aortic dissection, and this must be considered in the differential diagnosis. Information concerning cocaineinduced aortic dissection is limited, but one study of 38 consecutive patients with aortic dissection in a US urban center demonstrated a surprisingly high number (14, 37%) that were associated with cocaine use.…”

Section: Clinical Presentationmentioning

confidence: 99%

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

McCord¹,

Jneid²,

Hollander³

et al. 2008

Circulation

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365

131

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Section: Clinical Presentationmentioning

confidence: 99%

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

McCord¹,

Jneid²,

Hollander³

et al. 2008

Circulation

Self Cite

365

131

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“…Both non-ischemic early repolarization and LVH may confound the interpretation of the EKG (56,58). Cardiac enzymes also can be difficult to interpret in patients with CAMI.…”

Section: Diagnosismentioning

confidence: 95%

The cardiovascular effects of cocaine

Pozner

Levine

Zane

2005

The Journal of Emergency Medicine

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“…The initial ECG, chest pain characteristics, and other clinical factors useful for identifying myocardial ischemia or infarction in ED patients with chest pain 15,16 are less predictive in patients with cocaine-associated chest pain. In addition, the high incidence of baseline abnormalities, such as early repolarization, left ventricular hypertrophy, and ST segment elevation in patients without ischemia or infarction, 3 markedly limits the ability of the ECG to identify a low-risk patient cohort. In contrast, a significant number of patients with cocaine-associated MI have nonischemic ECGs.…”

Section: Discussionmentioning

confidence: 99%

“…Because baseline electrocardiogram (ECG) abnormalities 2,3 and atypical presentations are common among this population, 3,4 identification of low-risk patients is difficult, requiring serial sampling myocardial markers of necrosis in most of the patients. Total creatine kinase (CK) and its isozyme CK-MB are the markers most commonly used, although neither is entirely cardiac-specific.…”

mentioning

confidence: 99%

Utility of Troponin I in Patients with Cocaine-associated Chest Pain

et al. 2002

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Baseline electrocardiogram abnormalities and marker elevations not associated with myocardial necrosis make accurate diagnosis of myocardial infarction (MI) difficult in patients with cocaine-associated chest pain. Troponin sampling may offer greater diagnostic utility in these patients. Objective: To assess outcomes based on troponin positivity in patients with cocaine chest pain admitted for exclusion of MI. Methods: Outcomes were examined in patients admitted for possible MI after cocaine use. All patients underwent a rapid rule-in protocol that included serial sampling of creatine kinase (CK), CK-MB, and cardiac troponin I (cTnI) over eight hours. Outcomes included CK-MB MI (CK-MB Ն 8 ng/mL with a relative index [(CK-MB ϫ 100)/total CK] Ն 4, cardiac death, and significant coronary disease (Ն50%). Results: Of the 246 admitted patients, 34 (14%) met CK-MB criteria for MI and 38 (16%) had cTnI elevations. Angiography was performed in 29 of 38 patients who were cTnI-positive, with significant disease present in 25 (86%). Three of the four patients without significant disease who had cTnI elevations met CK-MB criteria for MI, and the other had a peak CK-MB level of 13 ng/mL. Sensitivities, specificities, and positive and negative likelihood ratios for predicting cardiac death or significant disease were high for both CK-MB MI and cTnI and were not significantly different. Conclusions: Most patients with cTnI elevations meet CK-MB criteria for MI, as well as have a high incidence of underlying significant disease. Troponin appears to have an equivalent diagnostic accuracy compared with CK-MB for diagnosing necrosis in patients with cocaine-associated chest pain and suspected MI.

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“Abnormal” electrocardiograms in patients with cocaine-associated chest pain are due to “normal” variants

Cited by 72 publications

References 34 publications

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

Management of Cocaine-Associated Chest Pain and Myocardial Infarction

The cardiovascular effects of cocaine

Utility of Troponin I in Patients with Cocaine-associated Chest Pain

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