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Cocaine-associated acute coronary syndrome — ABEM Board MCQ

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HardCardiovascular emergenciesCocaine-associated acute coronary syndromeABEM Board

A 39-year-old man arrives as ESI 2 with severe chest pain after cocaine use. BP 176/98, HR 126, ECG shows ST depressions in V3-V5, and troponin is elevated. Which of the following is the most appropriate next step in management?

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Correct answer: C — Treat as acute coronary syndrome with benzodiazepines, nitrates if tolerated, and antiplatelet therapy

Cocaine-associated ACS is managed as ACS with benzodiazepines and nitrates for sympathetic excess; avoid reflexive pure beta-blocker monotherapy in acute intoxication.

Reference: AHA scientific statement on cocaine-associated chest pain; ACEP ACS resources