Differential Diagnosis for Chest Pain with 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
- Cardiac Tamponade: Although less common, cardiac tamponade can occur due to various mechanisms related to cocaine use (e.g., myocardial rupture) and is critical to diagnose promptly due to its high mortality rate.
- Esophageal Perforation: Severe chest pain after cocaine use could also be due to esophageal perforation, which is a medical emergency requiring immediate intervention.
- Rare Diagnoses
- Spontaneous Coronary Artery Dissection (SCAD): While rare, SCAD can occur in the context of cocaine use, particularly in younger individuals without traditional cardiovascular risk factors.
- Stress-Induced (Takotsubo) Cardiomyopathy: Cocaine use can precipitate this condition, characterized by transient left ventricular dysfunction, which mimics ACS but has a different management approach.