Cocaine and heart disease - not a good combo. Several mechanisms for cardiac ischemia - increased workload from high SVR, coronoray vasospasm, and long term toxic cardiomyopathy. For more reading see this article via Medscape:
Cocaine Cardiomyopathy
Key point - beta blockers, particularly without concomitant alpha blockers, are generally a bad idea in chronic cocaine users.
Pearl - ST depressions always represent pathology, ST elevations may be normal, and are seen in several conditions other than acute myocardial infarction. Thease are summarized nicely in this NEJM article. 90% of young males will have upsloping ST elevations in lead V2 (data from old USAF study - hooah!). Read the article and impress your attending next time you do cards!
NEJM ST Elevation Article
Review of topics covered in morning report, M&m, and core conferences with links to supplemental reading material.
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