Early use of beta blockers in patients with cocaine associated chest pain

Abstract

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.

Keywords

• Cocaine
• Cocaine induced chest pain
• Unopposed alpha effect
• Beta blockers