The Medicine Forum

Article Title

Time for Reassessment: A Review of Beta-blockers in the Setting of Cocaine Associated Chest Pain and Acute Coronary Syndrome

Authors

Jonathan Finkel MD, Thomas Jefferson University Hospital
Gregary Marhefka, MD, Thomas Jefferson University HospitalFollow

Abstract

Introduction

Cocaine is the second most commonly used illicit drug in the United States, 1 and is the most frequent illicit substance to precipitate an emergency room visit, responsible for over 550,000 visits in 2007 alone. 2 The majority of patients present with a chief complaint of chest pain3, and approximately 6% are diagnosed with cocaine associated myocardial infarction.4For decades it has been thought that beta-blockade in the setting of cocaine use would precipitate coronary vasospasm and worsen cardiovascular outcomes due to unopposed alpha receptor stimulation. In 1999 this thinking was incorporated into the ACC/AHA guidelines, which currently recommend beta-blockers in all patients with an acute coronary syndrome except in the setting of prior cocaine use.4 Recently there have been several studies suggesting benefit from beta-blocker administration in patients with cocaine associated chest pain and myocardial ischemia.

Recommended Citation

Finkel MD, Jonathan and Marhefka, MD, Gregary (2010) "Time for Reassessment: A Review of Beta-blockers in the Setting of Cocaine Associated Chest Pain and Acute Coronary Syndrome," The Medicine Forum: Vol. 12, Article 7.
DOI: https://doi.org/10.29046/TMF.012.1.006
Available at: https://jdc.jefferson.edu/tmf/vol12/iss1/7