Differential Diagnosis for Chest Pain and Cocaine Use
- Single Most Likely Diagnosis
- Acute Coronary Syndrome (ACS): Cocaine use is a known risk factor for ACS due to its vasoconstrictive effects, which can lead to myocardial ischemia or infarction. The presentation of chest pain in a patient with recent cocaine use strongly suggests this diagnosis.
- Other Likely Diagnoses
- Acute Aortic Dissection: Cocaine use can cause hypertension, which increases the risk of aortic dissection. Chest pain associated with cocaine use could be due to this serious condition.
- Pulmonary Embolism: While less directly related to cocaine use than ACS, pulmonary embolism can cause chest pain and should be considered, especially if there are other risk factors present.
- Pneumothorax: Cocaine smoking can lead to pneumothorax due to barotrauma from inhalation or from the direct toxic effects of cocaine on the lungs.
- Do Not Miss Diagnoses
- Myocardial Infarction due to Coronary Artery Spasm: This is a potentially life-threatening condition that can be triggered by cocaine use. Missing this diagnosis could result in significant morbidity or mortality.
- Cardiac Tamponade: Although less common, cardiac tamponade can occur due to various mechanisms related to cocaine use (e.g., myocardial rupture) and is critical not to miss due to its high mortality rate if untreated.
- Rare Diagnoses
- Spontaneous Coronary Artery Dissection (SCAD): While rare, SCAD can occur and should be considered, especially in younger patients without traditional risk factors for coronary artery disease.
- Stress-Induced (Takotsubo) Cardiomyopathy: This condition, also known as "broken heart syndrome," can be triggered by the intense stress and catecholamine surge associated with cocaine use, leading to transient left ventricular dysfunction.