Case 10 – A Case of Chest Pain

Case #10: A Case of Chest Pain
Author: Christian Marcelo, MD
Peer Reviewer: Jill Theobold, MD, PhD

A 33 year old male with no past medical history presents with chest pain that began 30 minutes prior to arrival, lasted 10 minutes, and has now completely resolved.  On exam, he appears slightly agitated, diaphoretic, and his pupils are dilated. The remainder of his exam (including cardiac and pulmonary) is unremarkable. His ECG demonstrates sinus tachycardia and his cardiac enzymes are within normal limits. The paramedics state that they picked him up from a house party.

Vitals:             Temp: 98.2, HR: 128, RR: 10, BP: 184/102, O2 sat: 95% on RA

What toxidrome is this patient currently displaying?
How is cocaine used? What are the onsets and durations associated with each manner?
What is the mechanism of action of cocaine?
What other signs and symptoms can be observed in cocaine toxicity?
What is the clinical utility of a urine toxicology screen that is positive for cocaine?
What is the management of these patients?
How does cocaine use affect the evaluation of chest pain patients?

References

Levis JT, Garmel GM. Cocaine-associated chest pain. Emerg Med Clin North Am. 2005 Nov;23(4):1083-103.

Muirhead TT, Eide MJ. Images in clinical medicine. Toxic effects of levamisole in a cocaine user. N Engl J Med. 2011 Jun 16;364(24):e52.

Pozner CN, Levine M, Zane R. The cardiovascular effects of cocaine. J Emerg Med. 2005 Aug;29(2):173-8.

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