1. CARDIOVASCULAR EFFECTS OF COCAINE 1. TACHYCARDIA + HYPERTENSION 2. NON ISCHAEMIC CHEST PAIN 3. MYOCARDIAL ISCHAEMIA + INFARCTION 4. CORONARY ARTERY ANEURYSM + DISSECTION 5. AORTIC DISSECTION 6. DYSRHYTHMIAS Spontaneous LAD dissection http://dx.doi.org/10.1155/2012/420629 COCAINE-ASSOCIATED CHEST PAIN

2. PATHOPHYSIOLOGY Mayo Clin Proc. Dec 2011; 86(12): 1198–1207.

3. 1. ABCDE 2. 12-LEAD ECG 3. BLOOD TESTS 4. S/L GTN 5. PO ASPIRIN 6. IV DIAZEPAM 7. IV NITRATE INFUSION: for persisting pain (suspected cardiac origin) or evidence of ischaemia on ECG 8. CALCIUM CHANNEL BLOCKERS: consider in patients who do not respond to benzodiazepines and GTN. Caution in LV dysfunction or CCF. 9. PERSISTENT CHEST PAIN + ST ↑ NOT RELIEVED WITH DIAZEPAM, ASPIRIN AND NITRATES  FOLLOW LOCAL PROTOCOL FOR PCI. MANAGEMENT OF CHEST PAIN www.toxbase.org Mayo Clin Proc. Dec 2011; 86(12): 1198–1207. Circulation. 2008; 117: 1897-1907

4. AMERICAN HEART ASSOCIATION THERAPEUTIC + DIAGNOSTIC RECOMMENDATIONS Circulation. 2008; 117: 1897-1907