A Patient's Lie Masks the Cause of Chest Pain

A man in his 30s comes to your emergency department at 3 a.m. profoundly diaphoretic and reporting severe 10/10 chest pain. He has been at a party all night, and the chest pain started about 30 minutes earlier. He had a previous heart attack, but cannot remember many of the details. He reports no medication or drug use. No doubt this is a concerning presentation, and you immediately order an ECG, blood work, and an aspirin.   While this is in process, you review the electronic medical information, which reveals that the previous “heart attack” was actually observation for chest pain rule-out. The ECG showed nonspecific ST/T-wave changes, and serial troponin measurements were negative. He had undergone a stress echocardiogram, which was a good quality study, and demonstrated no inducible ischemia or reproducible symptoms. The patient had a urine drug screen during that previous admission, however, that was positive for cocaine.     With that information, cocaine-associated chest pain is high on your differential, but you have many questions and are not sure how to proceed.   How useful is a urine drug screen for determining if the patient used cocaine? The urine drug test for cocaine is highly specific (95%) and sensitive (99%). Cocaine itself is eliminated from urine in about 12 hours, but this can be delayed up to 72 hours in chronic or heavy users. The standard ELISA assay, however, does not test for cocaine, but instead for the metabolite benzoylecgonine, which is...
Source: Spontaneous Circulation - Category: Emergency Medicine Tags: Blog Posts Source Type: blogs