How does cocaine cause acute coronary symptoms?

And what symptoms should we look for to rule out an aortic dissection?

A young patient presents with localized chest pain radiating below the sternum, and has been experiencing palpitations, shortness of breath, and sweating uncontrollably for the past several hours. The patient has been using cocaine for the past 6 days, and has been self-treating their anxiety with alcohol.

This patient is experiencing cocaine associated chest pain. Cocaine stimulates the production of adrenaline and noradrenaline in the body and increases cardiac heart rate. Cocaine also causes blood vessels to constrict, which in turn increases blood pressure. These physiological changes make the heart have to work harder to pump blood around the body. In some cases, the constricted blood vessels cause blood to become stagnant, allowing it to form blood clots, which can led to acute coronary syndrome, or stroke.

Be sure to include rehydration therapy as part of your treatment of cocaine associated chest pain, as patients are almost always hypovolemic. Aspirin can also be administered to prevent blood clot formation.

Check out the original Figure 1 post here:

Chapters
0:00 Case Description
0:51 Vitals and Physical Exam
1:32 Pathology
3:28 Diagnostic Results
4:16 Treatment
5:04 Conclusion

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