Zimmerman J L, Dellinger R P, Majid P A
Department of Medicine, Baylor College of Medicine, Houston, Texas.
Ann Emerg Med. 1991 Jun;20(6):611-5. doi: 10.1016/s0196-0644(05)82377-7.
To describe the clinical and ECG features of cocaine abusers evaluated in the emergency department and admitted to the medical coronary care unit with chest pain consistent with myocardial ischemia.
A four-month retrospective review of all cocaine abusers who presented to the ED with chest pain and a diagnosis of possible myocardial infarction.
Urban county hospital.
Forty-eight adult cocaine abusers admitted with chest pain.
Patients included 34 men and 14 women with a mean age of 29 +/- 7.3 years. The average duration of cocaine abuse in 28 patients for whom it was reported was 5 +/- 4.8 years. Chest pain occurred within one hour of cocaine abuse in 13 admissions (27%), more than one hour after abuse in 13 admissions (27%), and it was not recorded in 23 admissions (47%). Initial ECGs were evaluated in all patients and revealed significant repolarization abnormalities consisting of abnormal ST segment elevations in 18 (37%) and T-wave inversions in 20 (41%) that often persisted on subsequent ECGs. Three patients sustained acute myocardial infarctions.
Our findings confirm a small but significant incidence of myocardial infarction in cocaine abusers presenting to the ED with chest pain. The chronicity of cocaine abuse, the persistence of ECG abnormalities, and the variable temporal relationship of chest pain to cocaine abuse suggest possible chronic myocardial changes as etiologies of ischemia.
描述在急诊科接受评估并因胸痛与心肌缺血相符而入住医疗冠心病监护病房的可卡因滥用者的临床和心电图特征。
对所有因胸痛就诊于急诊科且诊断为可能心肌梗死的可卡因滥用者进行为期四个月的回顾性研究。
城市县医院。
48名因胸痛入院的成年可卡因滥用者。
患者包括34名男性和14名女性，平均年龄29±7.3岁。报告了可卡因滥用时间的28名患者中，平均滥用时间为5±4.8年。13例入院患者（27%）在滥用可卡因后1小时内出现胸痛，13例入院患者（27%）在滥用后1小时以上出现胸痛，23例入院患者（47%）未记录胸痛出现时间。对所有患者的初始心电图进行评估，发现显著的复极异常，包括18例（37%）ST段异常抬高和20例（41%）T波倒置，这些异常在后续心电图中常持续存在。3例患者发生急性心肌梗死。
我们的研究结果证实，因胸痛就诊于急诊科的可卡因滥用者中心肌梗死发生率虽低但具有显著性。可卡因滥用的长期性、心电图异常的持续性以及胸痛与可卡因滥用的时间关系变化表明，可能存在慢性心肌改变作为缺血的病因。
