What should I do if I experience chest pain and have a history of vaping?

Chest Pain with History of Vaping: Immediate Evaluation Required

If you experience chest pain and have a history of vaping, you should seek immediate medical attention as this could indicate e-cigarette or vaping product use-associated lung injury (EVALI) or other serious conditions requiring prompt treatment. 1

Initial Assessment Algorithm

Step 1: Determine Severity and Need for Emergency Care

• Seek emergency care immediately if you have:
  • Severe, continuous chest pain
  • Shortness of breath or difficulty breathing
  • Coughing, especially if producing bloody sputum
  • Rapid heart rate or palpitations
  • Fever
  • Nausea or vomiting
  • Dizziness or lightheadedness 1, 2

Step 2: Medical Evaluation (At Emergency Department)

The following tests will likely be performed:

• 12-lead ECG (within first 5 minutes)
• Chest X-ray (even if normal, CT scan may be needed)
• Blood tests including:
  • Cardiac biomarkers (troponin)
  • Complete blood count
  • Comprehensive metabolic panel
  • Inflammatory markers 1, 2

EVALI Considerations

EVALI is a serious condition associated with vaping that can present with chest pain and respiratory symptoms. Recent evidence shows that EVALI patients may have:

• Constitutional symptoms (88% of patients)
• Respiratory symptoms (98%)
• Gastrointestinal symptoms (90%) 3

Imaging Findings

Chest imaging may reveal various patterns of lung injury associated with vaping, which have only recently been recognized. These findings are crucial for diagnosis and treatment planning 4.

Treatment Approach

Treatment typically involves:

• Discontinuation of all e-cigarette and vaping products
• Possible corticosteroid therapy (used in 95% of cases in recent studies)
• Antibiotics if infection is suspected
• Supportive care and monitoring 1, 3

Follow-Up Care

If diagnosed with EVALI:

• Outpatient follow-up within 48 hours after hospital discharge is critical
• Pulmonary specialist follow-up within 2-4 weeks
• Longer-term monitoring may include pulmonary function tests and chest imaging 1

Important Cautions

• Do not resume vaping - Continued use can worsen lung injury and lead to rehospitalization
• Complete prescribed treatments - Adherence to medication regimens, particularly corticosteroid tapers, is essential
• Watch for worsening symptoms - Seek immediate care if symptoms return or worsen 1

Risk Stratification

Even if initial evaluation suggests low risk, chest pain with a history of vaping should not be dismissed. Studies show that patients with chest pain of uncertain origin can be stratified by risk factors, but vaping history adds complexity to this assessment 5, 6.

Remember that chest pain has many potential causes, and while musculoskeletal pain (reproducible by palpation) is common, serious conditions must be ruled out first 7.