“In patients with cocaine-induced chest pain and hypertension, initial management with an intravenous benzodiazepine can relieve chest pain and produce beneficial cardiac hemodynamic effects. In addition, by reducing the central stimulatory effects of cocaine, benzodiazepines also reduce anxiety, which often leads to resolution of the hypertension and tachycardia. Administration of sublingual or intravenous nitroglycerin and intravenous or oral calcium channel blockers is recommended for patients with ST-segment elevation or depression that accompanies ischemic chest discomfort after cocaine use.
By blocking only β-receptors, resulting in an unopposed α-adrenergic effect, β-blockers can exacerbate vasoconstriction and should therefore be avoided. Although labetalol is both an α- and β-blocker, because it blocks β-receptors substantially more, it is thought to offer no advantages over a β-blocker.
- McCord J, Jneid H, Hollander JE, et al: Management of cocaine-associated chest pain and myocardial infarction: A scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 2008;117(14);1897-1907.
http://circ.ahajournals.org/cgi/content/full/117/14/1897 - Wright RS, Anderson JL, Adams CD, et al: 2011 ACCF/AHA Focused Update of the Guidelines for the Management of Patients With Unstable Angina/ Non-ST-Elevation Myocardial Infarction (Updating the 2007 Guideline): A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011;123(18):2022-2060.
http://circ.ahajournals.org/content/123/18/2022.long
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