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Chest Pain (Cocaine/Stimulant Ingestion)

Date Last Search Run: Nov 06, 2025
Table last updated: Mar 31, 2023
Data last added: Mar 31, 2023

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)      
3 (weak evidence exists)    


Interventions

12-Lead ECG
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) AMI recognition Process ED-MD Hollander JE., Hoffman RS., Gennis P., Fairweather P., DiSano MJ., Schumb DA., et al. Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. Acad Emerg Med 1994; 1(4):330-9. Medline
III Supportive (Green) AMI recognition Process ED-MD Wieler J, Mostafa AMT. Reprint of: Cocaine induced chest pain and acute coronary syndrome. Dis Mon 2022; 68(9):101407. Medline

Analgesia (narcotic)
Level Direction Primary Outcome Patient/Process Setting Reference

Benzodiazepines
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Chest pain relief Patient ED-MD Honderick T., Williams D., Seaberg D., Wears R. A prospective, randomized, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes. Am J Emerg Med 2003; 21(1):39-42. Medline
III Supportive (Green) Chest pain resolution (measured by visual analog scale) Patient ED-MD Baumann BM., Perrone J., Hornig SE., Shofer FS., Hollander JE. Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Acad Emerg Med 2000; 7(8):878-85. Medline

Beta Blockers
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Reversal of Segment elevation Patient ED-MD Akay S., Ozdemir M. Acute coronary syndrome presenting after pseudoephedrine use and regression with beta-blocker therapy. Can J Cardiol 2008; 24(11):e86-8. Medline

Chest pain prediction tool
Level Direction Primary Outcome Patient/Process Setting Reference
II Opposes (Red) Assessment of 30-day major adverse cardiac event(s) Patient ED-MD Faramand Z, Martin-Gill C, SO F, Callaway C, Al-Zaiti S. The prognostic value of HEART score in patients with cocaine associated chest pain: An age-and-sex matched cohort study. Am J Emerg Med 2021; 45:303–8. Medline
X Not Yet Graded (White) - Gresnigt F, J van E, Hunault C, Franssen E, de Lange D, Riezebos R. Comparative evaluation of the ability to detect major cardiac events with the modified cocaine history, electrocardiogram, age, risk factors and troponin (HEART) score, HEART pathway and original HEART score in patients with cocaine-associated chest pain . Clin Toxicol May 2025; 63(5):317-24. Medline

Nitrates
Level Direction Primary Outcome Patient/Process Setting Reference

Securing tube
Level Direction Primary Outcome Patient/Process Setting Reference


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