Podcast 764: Myth or Merit: Beta-Blockers for Cocaine Chest Pain

<p><strong>Contributor: Chris Holmes, MD</strong></p> <p><strong>Educational Pearls:</strong></p> <ul> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Many are taught that patients with cocaine chest pain should not receive beta-blockers due to unopposed alpha agonism, but is this true?</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">363 consecutive admissions for chest pain with positive cocaine on urine toxicology were reviewed in a retrospective cohort study</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">60 patients in this cohort received a beta-blocker and multivariate analysis demonstrated a reduction in myocardial infarction risk</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Another retrospective cohort study demonstrated no association of negative outcomes with beta-blocker administration in those with a recent positive result on cocaine urine toxicology</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">Two more recent meta-analyses were performed finding no association between adverse clinical outcomes and beta-blocker administration for cocaine chest pain</span></li> <li style="font-weight: 400;" aria-level="1"><span style= "font-weight: 400;">No prospective randomized-controlled trials have been performed to evaluate the use of beta-blockers for treatment of cocaine chest pain in the ED setting</span></li> </ul> <p><strong>References</strong></p> <p><span style="font-weight: 400;">Dattilo PB, Hailpern SM, Fearon K, Sohal D, Nordin C. Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use [published correction appears in Ann Emerg Med. 2008 Jul;52(1):90]. Ann Emerg Med. 2008;51(2):117-125. doi:10.1016/j.annemergmed.2007.04.015</span></p> <p><span style="font-weight: 400;">Rangel C, Shu RG, Lazar LD, Vittinghoff E, Hsue PY, Marcus GM. Beta-blockers for chest pain associated