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

Chest Pain with History of Vaping: Urgent 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: Immediate Medical Evaluation

• Go to an emergency department if you experience:
  • Severe, continuous chest pain
  • Shortness of breath
  • Fever
  • Rapid heart rate
  • Oxygen saturation below 95%
  • Any signs of respiratory distress 1, 2

Step 2: Diagnostic Workup

At the healthcare facility, expect:

• 12-lead ECG (within first 5 minutes of evaluation)
• Chest radiography (may show patterns specific to vaping-related injury) 3
• Blood tests including:
  • Cardiac biomarkers (troponin)
  • Complete blood count
  • Arterial blood gas
  • Blood chemistry 2
• Possible CT scan (even if chest X-ray appears normal) 1, 3

Understanding EVALI

EVALI presents with a combination of:

• Respiratory symptoms (98% of cases): cough, shortness of breath, chest pain
• Constitutional symptoms (88% of cases): fever, chills, fatigue
• Gastrointestinal symptoms (90% of cases): nausea, vomiting, abdominal pain, diarrhea 4

Treatment Approach

Treatment typically involves:

1. Complete cessation of all e-cigarette and vaping products - this is critical for recovery 1
2. Possible corticosteroid therapy (used in 95% of cases) 4
3. Empiric antibiotics until infection is ruled out 1
4. Supportive care based on symptom severity

Follow-up Care

If diagnosed with EVALI:

• Initial outpatient follow-up within 48 hours after hospital discharge 1
• Pulmonary specialist follow-up within 2-4 weeks 1
• Pulmonary function testing 1-2 months after discharge 1

Important Considerations

Warning Signs Requiring Immediate Return to Hospital

• Worsening shortness of breath
• Chest pain that intensifies
• Decreased oxygen levels
• Signs of adrenal insufficiency if on corticosteroids (fatigue, decreased appetite, dizziness) 1

Risk Factors for More Severe Disease

• History of cardiac or respiratory conditions
• Continued use of vaping products
• Delayed medical attention 1

Prevention

The most effective prevention strategy is complete cessation of all e-cigarette and vaping products. Many patients show residual abnormalities on chest imaging and pulmonary function tests even after initial recovery, indicating potential long-term effects 4.

Pitfalls to Avoid

1. Don't delay seeking care - chest pain in the setting of vaping history should never be dismissed as minor
2. Don't resume vaping - relapse with vaping has been associated with rehospitalization 4
3. Don't assume chest pain is non-cardiac - vaping can affect both the lungs and heart 2
4. Don't miss follow-up appointments - early follow-up has been shown to prevent adverse outcomes 1

Remember that EVALI remains a clinical diagnosis that requires a high index of suspicion, particularly in patients with a history of vaping who present with respiratory, constitutional, and gastrointestinal symptoms 4.