Early use of beta blockers in patients with cocaine associated chest pain
Background: The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of...
| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2015-09-01
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| Series: | International Journal of Cardiology: Heart & Vasculature |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S235290671530004X |
| _version_ | 1818062575828467712 |
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| author | Christian Espana Schmidt Luciano Pastori Gerald Pekler Ferdinand Visco Savi Mushiyev |
| author_facet | Christian Espana Schmidt Luciano Pastori Gerald Pekler Ferdinand Visco Savi Mushiyev |
| author_sort | Christian Espana Schmidt |
| collection | DOAJ |
| description | Background: The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an “unopposed alpha adrenergic effect (UAE)”.
Objectives: Identify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain.
Methods: We performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared.
Results: No statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes.
Conclusions: This study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP.
Implications: BB appeared safe when given early on admission to patients with CICP. |
| first_indexed | 2024-12-10T14:06:24Z |
| format | Article |
| id | doaj.art-45b1500bb02442ca96ccdad995ee2e7c |
| institution | Directory Open Access Journal |
| issn | 2352-9067 |
| language | English |
| last_indexed | 2024-12-10T14:06:24Z |
| publishDate | 2015-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology: Heart & Vasculature |
| spelling | doaj.art-45b1500bb02442ca96ccdad995ee2e7c2022-12-22T01:45:39ZengElsevierInternational Journal of Cardiology: Heart & Vasculature2352-90672015-09-018C16716910.1016/j.ijcha.2015.06.001Early use of beta blockers in patients with cocaine associated chest painChristian Espana Schmidt0Luciano Pastori1Gerald Pekler2Ferdinand Visco3Savi Mushiyev4Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United StatesDepartment of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United StatesUnit of Cardiology, Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United StatesUnit of Cardiology, Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United StatesUnit of Cardiology, Department of Medicine, Metropolitan Hospital Center/New York Medical College, New York, NY, United StatesBackground: The most common symptom of cocaine abuse is chest pain. Cocaine induced chest pain (CICP) shares patho-physiological pathways with the acute coronary syndromes (ACS). A key event is the increase of activity of the adrenergic system. Beta blockers (BBs), a cornerstone in the treatment of ACS, are felt to be contraindicated in the patient with CICP due to a potential of an “unopposed alpha adrenergic effect (UAE)”. Objectives: Identify signs of UAE and in-hospital complications in patients who received BB while having cocaine induced chest pain. Methods: We performed a retrospective review of 378 patients admitted to a medical unit because of CICP. Twenty six of these were given a BB at the time of admission while having CICP. We compared these patients to a control group paired by age, sex, race and history of hypertension who did not received a BB while having CICP. Blood pressure, heart rate, length of stay and in-hospital cardiovascular complications were compared. Results: No statistically significant differences were found between the two groups except for a longer length of stay in the case group. This was felt to be due to unrelated causes. Conclusions: This study does not support the presence of an UAE in patients with continuing CICP and treated early with BB. There were no in-hospital cardiovascular complications in the group of patients who had an early dose of BB while having CICP. Implications: BB appeared safe when given early on admission to patients with CICP.http://www.sciencedirect.com/science/article/pii/S235290671530004XCocaineCocaine induced chest painUnopposed alpha effectBeta blockers |
| spellingShingle | Christian Espana Schmidt Luciano Pastori Gerald Pekler Ferdinand Visco Savi Mushiyev Early use of beta blockers in patients with cocaine associated chest pain International Journal of Cardiology: Heart & Vasculature Cocaine Cocaine induced chest pain Unopposed alpha effect Beta blockers |
| title | Early use of beta blockers in patients with cocaine associated chest pain |
| title_full | Early use of beta blockers in patients with cocaine associated chest pain |
| title_fullStr | Early use of beta blockers in patients with cocaine associated chest pain |
| title_full_unstemmed | Early use of beta blockers in patients with cocaine associated chest pain |
| title_short | Early use of beta blockers in patients with cocaine associated chest pain |
| title_sort | early use of beta blockers in patients with cocaine associated chest pain |
| topic | Cocaine Cocaine induced chest pain Unopposed alpha effect Beta blockers |
| url | http://www.sciencedirect.com/science/article/pii/S235290671530004X |
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