EVALUATION OF PATIENTS WITH CHEST PAIN AFTER COCAINE USE

Cocaine remains the most common cause of illicit drug-related visits t o emergency departments, 40% of which result from chest pain. It is es timated that over half of the 64,000 patients evaluated annually for c ocaine-associated chest pain will be admitted to hospitals for the eva luation of myocardial ischemia or infarction, at a health care cost of over eighty million dollars. Although the link between cocaine use an d myocardial ischemia is well established, only about 6% of patients w ith cocaine-associated chest pain will demonstrate biochemical evidenc e of myocardial infarction. This article focuses on the evaluation of patients with chest pain following cocaine use, and concentrates on wa ys to improve diagnosis, management, and utilization of health care se rvices.