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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, December 10, 2020

Cocaine and ST Elevation

emDocs - December 10, 2020 - By Brannon Inman and Lloyd Tannenbaum
Reviewed by: Jamie Santistevan; Manpreet Singh and Brit Long
"Cocaine causes a huge catecholaminergic surge. All those catecholamines cause vessels to clamp down (vasoconstriction). They also make the heart pump harder (inotropy) and faster (chronotropy). So, you have coronary vessels getting smaller and cardiac muscle working harder. This sounds bad. To make it even worse, the chronotropic effects of cocaine are increased when alcohol is used on top of the cocaine...
In 1994 a group of EM physicians (and cardiologists) wanted to determine which patients coming to the ED with chest pain after cocaine use were having a true MI (in this study, MI is defined as having elevated CK-MB). They enrolled 246 patients over 46 months and looked at ECGs, cardiac biomarkers, echocardiograms and catheterization reports. This study, known as COCHPA or the Cocaine Associated Chest Pain Study, enrolled 246 patients, 14 of which had an MI based on elevated CK-MB level (5.7%; 95% confidence interval [CI], 2.7-8.7%). In this study, an ECG revealing ischemia or infarction had a 35.7% sensitivity for predicting a true MI. This low sensitivity would mean that you cannot exclude acute MI just based on the absence of ischemic changes on the ECG..."