Cardiac and Hemodynamic Assessment of Patients with Cocaine-Associated Chest Pain Syndromes

Abstract

Background: Animal and human experimental studies have yielded conflicted data regarding the effects of cocaine on cardiovascular function. We studied the cardiac and hemodynamic profiles in emergency department chest pain patients following recent cocaine use. Methods: After obtaining informed consent, emergency department patients who presented with a chief complaint of chest pain and cocaine use within 24 hours of arrival were prospectively enrolled. All patients underwent a structured 40-item history and physical examination and were placed on the IQ Noninvasive Hemodynamic Surveillance System (Renaissance Technology, Inc., Newton, PA), a validated transthoracic cardiac output monitor. The principal measurements obtained included cardiac output, cardiac index, and stroke volume. Data were analyzed with standard descriptive techniques. Results: Twenty-seven patients were enrolled (median age, 37 years [range, 23–54]; 74% male). Patients used a mean of $200 worth of cocaine, usually crack (67%). Patients had a history of tobacco use (82%), prior myocardial infarction (33%), and prior cocaine-associated chest pain (67%). The median (interquartile range; IQR) for the hemodynamic parameters were: mean arterial blood pressure 92 mm Hg (IQR 85–100); heart rate 83/min (IQR 72–98); cardiac output 6.9 L/min (IQR 5.1–7.2); cardiac index 3.2 L/min/m² (IQR 2.4–4.0); stroke volume 78 mL/beat (IQR 64–93). Conclusion: Most emergency department patients with cocaine-associated chest pain have normal cardiac profiles at the time of presentation. The negative inotropic effects of high doses of cocaine observed in animal models do not appear to be present in patients who develop chest pain after using recreational doses of cocaine.