Cocaine-associated chest pain

Emergency Medicine Clinics of North America

Volumn 23, Issue 4, 2005, Pages 1083-1103

  Levis, Joel T ^a,b   Garmel, Gus M ^a,b  

^a KAISER PERMANENTE   (United States)

^b STANFORD UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

ACETYLSALICYLIC ACID; ALPHA ADRENERGIC RECEPTOR BLOCKING AGENT; CALCIUM CHANNEL BLOCKING AGENT; COCAINE; DIAZEPAM; DILTIAZEM; ESMOLOL; GLYCERYL TRINITRATE; HOMOCOCAINE; LIDOCAINE; LORAZEPAM; NIFEDIPINE; PHENTOLAMINE; VERAPAMIL;

AGITATION; ATHEROSCLEROSIS; BETA ADRENERGIC RECEPTOR BLOCKING; BRAIN TOXICITY; CARDIOTOXICITY; CARDIOVASCULAR RISK; CHOLINESTERASE BLOOD LEVEL; COMPUTER ASSISTED TOMOGRAPHY; CORONARY ARTERY CONSTRICTION; DECOMPOSITION; DETOXIFICATION; DIFFERENTIAL DIAGNOSIS; DISEASE ASSOCIATION; DRUG HALF LIFE; DRUG METABOLISM; ELECTROCARDIOGRAM; FOLLOW UP; HEART INFARCTION; HEART MUSCLE ISCHEMIA; HEART VENTRICLE FIBRILLATION; HEART VENTRICLE TACHYCARDIA; HOSPITALIZATION; HUMAN; HYPERTHERMIA; HYPOTENSION; INTENSIVE CARE UNIT; MEDICAL RESEARCH; NONHUMAN; PATHOPHYSIOLOGY; PRIORITY JOURNAL; REVIEW; THORAX PAIN; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; VASOCONSTRICTION;

EID: 25844446799     PISSN: 07338627     EISSN: 07338627     Source Type: Journal    
DOI: 10.1016/j.emc.2005.07.009     Document Type: Review

References (136)

1. R.W. Derlet, and B.Z. Horowitz Advances and updates in cardiovascular emergencies: cardiotoxic drugs Emerg Med Clin North Am 13 4 1995 771 791
2. C. Van Dyke, and R. Byck Cocaine Sci Am 246 1982 128 141
3. J. Kennedy Coca exotica: the illustrated story of cocaine 1985 Farleigh Dickinson University Press Rutherford (NJ)
4. E.A. Warner Cocaine abuse Ann Intern Med 119 3 1993 226 235
5. S.B. Karch A brief history of cocaine 1998 CRC Press Boca Raton (FL)
6. D. Streatfeild Cocaine: an unauthorized biography 2002 St. Martin's Press New York
7. I.H. Hahn, and R.S. Hoffman Diagnosis and treatment of acute myocardial infarction: cocaine use and acute myocardial infarction Emerg Med Clin North Am 19 2 2001 1 18
8. G. Hals, and W. Richardson Drugs of abuse and their complications: emergency department evaluation and management: part I Emerg Med Rep 22 12 2001 131 146
9. US Drug Enforcement Administration. The Controlled Substance Act (CSA). Title II of the Comprehensive Drug Abuse Prevention and Control Act of 1970. Available at: http://www.dea.gov. Accessed August 21, 2005.
10. Office of National Drug Control Policy What America's Users Spend on Illegal Drugs. 1998-2000; Available at: http://www.whitehousedrugpolicy.gov. Accessed August 21, 2005.
11. Substance Abuse and Mental Health Statistics (SAMHSA). 2002 National survey on drug use and health: national findings. Available at: http://www.oas.samhsa.gov. Accessed August 21, 2005.
12. E. Rivers, E. Shirazi, and T. Aurora Brief reports: cocaine use in elder patients presenting to an inner-city emergency department Acad Emerg Med 11 2004 874 877
13. Drug Abuse Warning Network (DAWN). Emergency department trends. Final estimates 1995-2002. Available at: http://www.dawninfo.samhsa.gov. Accessed August 21, 2005.
14. J.A. Rich, and D.E. Singer Cocaine-related symptoms in patients presenting to an urban emergency department Ann Emerg Med 20 6 1991 616 621
15. L.L. Cregler, and H. Mark Special report: medical complications of cocaine abuse N Engl J Med 315 23 1986 1495 1499
16. R.S. Hoffman, and J.E. Hollander Evaluation of patients with chest pain after cocaine use Crit Care Clin 13 1997 809 828
17. S.L. Brody, C.M. Slovis, and K.D. Wrenn Cocaine-related medical problems: consecutive series of 233 patients Am J Med 88 1990 325 331
18. J.E. Hollander Current concepts: the management of cocaine-associated myocardial ischemia N Engl J Med 333 19 1995 1267 1272
19. P.D. Mueller, N.L. Benowitz, and K.R. Olson Emergency aspects of drug abuse: cocaine Emerg Med Clin North Am 8 3 1990 481 493
20. W.H. Frishman, A. Karpenos, and T.J. Molloy Cocaine-induced coronary artery disease: recognition and treatment Med Clin North Am 73 2 1989 475 486
21. R.A. Lange, and D. Hillis Medical progress: cardiovascular complications of cocaine use N Engl J Med 345 5 2001 351 358
22. R.A. Kloner, and S.H. Rezkalla Cocaine and the heart N Engl J Med 348 6 2003 487 488
23. L.R. Goldfrank, and R.S. Hoffman The cardiovascular effects of cocaine Ann Emerg Med 20 2 1991 165 175
24. L.B. Burnett Toxicity, cocaine Emedicine July 2002 p. 1-52
25. M.B. Erwin, and E.N. Deliargyris Cardiology grand rounds from the University of North Carolina at Chapel Hill: cocaine-associated chest pain Am J Med Sci 324 1 2002 37 44
26. J.A. Madden, and R.H. Powers Effects of cocaine and cocaine metabolites on cerebral arteries in vivo Life Sci 47 1990 1109-14
27. 3H] benzoylecgonine and pharmacological activity of some cocaine metabolites J Pharm Pharmacol 27 1975 784 786
28. R.D. Weiss, and F.H. Gawin Protracted elimination of cocaine metabolites in long-term high-dose cocaine abusers Am J Med 85 1988 879 880
29. R.S. Hoffman, G.C. Henry, and M.A. Howland Association between life-threatening cocaine toxicity and plasma cholinesterase activity Ann Emerg Med 21 1992 247 253
30. E.F. McCance, L.H. Price, and T.R. Kosten Cocaethylene: pharmacology, physiology and behavioral effects in humans J Pharmacol Exp Ther 274 1 1995 215 223
31. W.V. Vanek, H.I. Dickey-White, and S.A. Signs Concurrent use of cocaine and alcohol by patients treated in the emergency department Ann Emerg Med 28 1996 508 514
32. P. Jatlow Cocaethylene: pharmacologic activity and clinical significance Ther Drug Monit 15 1993 533 536
33. J.E. Hollander, and R.S. Hoffman Cocaine-induced myocardial infarction: an analysis and review of the literature J Emerg Med 10 1992 169 177
34. A. Tun, and I.A. Khan Myocardial infarction with normal coronary arteries: the pathologic and clinical perspectives Angiology 52 5 2001 299 304
35. F.H. Zimmerman, G.M. Gustafson, and H.G. Kemp Recurrent myocardial infarction associated with cocaine abuse in a young man with normal coronary arteries: evidence for coronary artery spasm culminating in thrombosis J Am Coll Cardiol 9 1987 964 968
36. W.H. Frishman, A. Del Vecchio, and S. Sanal Cardiovascular manifestations of substance abuse part 1: cocaine Heart Dis 5 3 2003 187 201
37. R.L. Minor, B.D. Scott, and D.D. Brown Cocaine-induced myocardial infarction in patients with normal coronary arteries Ann Intern Med 115 10 1991 797 806
38. R.A. Lange, R.G. Cigarroa, and C.W. Yancy Cocaine-induced coronary-artery vasoconstriction N Engl J Med 321 23 1989 1557 1562
39. W.R. Pitts, R.A. Lange, and J.E. Cigarroa Cocaine-induced myocardial ischemia and infarction: pathophysiology, recognition, and management Prog Cardiovasc Dis 40 1 1997 65 76
40. R.A. Lange, R.G. Cigarroa, and E.D. Flores Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade Ann Intern Med 112 12 1990 897 903
41. E.D. Flores, R.A. Lange, and R.G. Cigarroa Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses J Am Coll Cardiol 16 1990 74 79
42. B.H. Negus, J.E. Willard, and L.D. Hillis Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil Am J Cardiol 73 1994 510 512
43. J.E. Hollander, R.S. Hoffman, and P. Gennis Prospective multicenter evaluation of cocaine-associated chest pain Acad Emerg Med 1 4 1994 330 339
44. J.E. Hollander, R.S. Hoffman, and P. Gennis Cocaine-associated chest pain: one-year follow-up Acad Emerg Med 2 1995 179 184
45. J.E. Hollander, R.S. Hoffman, and J.L. Burstein Cocaine-associated myocardial infarction: mortality and complications Arch Intern Med 155 1995 1081 1086
46. J.E. Hollander, H.C. Thode, and R.S. Hoffman Chest discomfort, cocaine, and tobacco Acad Emerg Med 2 3 1995 238
47. D.J. Moliterno, J.E. Willard, and R.A. Lange Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both N Engl J Med 330 1994 454 459
48. S.H. Rezkalla, J.J. Mazza, and R.A. Kloner Effects of cocaine on human platelets in healthy subjects Am J Cardiol 72 1993 243 246
49. G. Togna, E. Tempesta, and A.R. Togna Platelet responsiveness and biosynthesis of thromboxane and prostacycline in response to in vitro cocaine treatment Haemostasis 15 2 1985 100 107
50. C.L. Bement, L. Cohen, and S.W. Nielsen Arterial injury in rabbits following alternate-day injections of cocaine FASEB J 3 1989 A297
51. M.J. Zurbano, M. Heras, and M. Rigol Cocaine administration enhances platelet reactivity to subendothelial components: studies in a pig model Eur J Clin Invest 27 2 1997 116 120
52. C.M. Heesch, C.R. Wilhelm, and J. Ristich Cocaine activates platelets and increases the formation of circulating platelet containing microaggregates in humans Heart 83 2000 688 695
53. H.D. Tazelaar, S.B. Karch, and B.G. Stephens Cocaine and the heart Hum Pathol 18 1987 195 199
54. E.J. Eichhorn, E. Peacock, and P.A. Grayburn Chronic cocaine abuse is associated with accelerated atherosclerosis in human coronary arteries J Am Coll Cardiol 19 Suppl 1992 105A [Abstract.]
55. R.E. Mittleman, and C.V. Welti Cocaine and sudden "natural" death J Forensic Sci 32 1987 11 19
56. F.D. Kolodgie, R. Virmani, and J.F. Cornhill Increase in atherosclerosis and adventitial mast cells in cocaine abusers: an alternative mechanism of cocaine-associated coronary vasospasm and thrombosis J Am Coll Cardiol 17 7 1991 1553 1560
57. F.A. Dressler, S. Malekzadeh, and W.C. Roberts Quantitative analysis of amounts of coronary arterial narrowing in cocaine addicts Am J Cardiol 65 1990 303 308
58. J.E. Hollander, J.L. Burstein, and R.S. Hoffman Cocaine-associated myocardial infarction: clinical safety of thrombolytic therapy Chest 107 5 1995 1237 1241
59. H.W.B. Smith, H.A. Liberman, and S.L. Brody Acute myocardial infarction temporally related to cocaine use: clinical, angiographic, and pathophysiologic observations Ann Intern Med 107 1987 13 18
60. P.A. Majid, B. Patel, and H.-S. Kim An angiographic and histologic study of cocaine-induced chest pain Am J Cardiol 65 1990 812 814
61. M. Amin, G. Gabelman, and J. Karpel Acute myocardial infarction and chest pain syndromes after cocaine use Am J Cardiol 66 1990 1434 1437
62. L.D. Wilson Rapid progression of coronary artery disease in the setting of chronic cocaine abuse J Emerg Med 16 4 1998 631 634
63. M.C. Kontos, R.L. Jesse, and J.L. Tatum Coronary angiographic findings in patients with cocaine-associated chest pain J Emerg Med 24 1 2003 9 13
64. K. Nademanee, D.A. Gorelick, and M.A. Josephson Myocardial ischemia during cocaine withdrawal Ann Intern Med 111 1989 876 880
65. M.J.A. Barbera, G.J. Vallejo, and P.M. Velo Spontaneous pneumomediastinum after cocaine inhalation Respiration (Herrlisheim) 50 3 1986 230 232
66. D. Palat, M. Denson, and M. Sherman Pneumomediastinum induced by inhalation of alkaloidal cocaine N Y State J Med 88 8 1988 438 439
67. R. Hoffman New case - summary: adult male with neck discomfort Int J Med Toxicol 1 4 1998 17
68. M. Maeder, and E. Ullmer Pneomomediastinum and bilateral pneumothorax as a complication of cocaine smoking Respiration (Herrlisheim) 70 4 2003 407
69. S.M. Janes, P.W. Ind, and J. Jackson Images in thorax: crack inhalation induced pneumomediastinum Thorax 59 2004 360
70. K.C. Wilson, and J.J. Saukkonen Acute respiratory failure from abused substances J Intensive Care Med 19 2004 183 193
71. D.Y. Haim, M.L. Lippmann, and S.K. Goldberg The pulmonary complications of crack cocaine: a comprehensive review Chest 107 1995 233 240
72. R.A. Chang, and N.F. Rossi Intermittent cocaine use associated with recurrent dissection of the thoracic and abdominal aorta Chest 108 6 1995 1758 1762
73. E. Neri, T. Toscano, and M. Massetti Cocaine-induced intramural hemotoma of the ascending aorta Tex Heart Inst J 28 3 2001 218 219
74. B.K. Nallamothu, S. Saint, and T.J. Kolias Clinical problem-solving: of nicks and time N Engl J Med 345 5 2001 359 363
75. P.Y. Hsue, C.L. Salinas, and A.F. Bolger Acute aortic dissection related to crack cocaine Circulation 105 2002 1592 1595
76. A.D. Perron, and M. Gibbs Thoracic aortic dissection secondary to crack cocaine ingestion Am J Emerg Med 15 1997 507 509
77. K.A. Eagle, E.M. Isselbacher, and R.W. DeSanctis Cocaine-related aortic dissection in perspective Circulation 105 2002 1529 1530
78. I.A. Khan, and C.K. Nair Clinical, diagnostic, and management perspectives of aortic dissection Chest 122 2002 311 328
79. M. Ozkan, R.A. Dweik, and M. Ahmad Drug-induced lung disease Cleve Clin J Med 68 9 2001 782 795
80. H.H. Osborn, M. Tang, and K. Bradley New-onset bronchospasm or recrudescence of asthma associated with cocaine abuse Acad Emerg Med 4 1997 689 692
81. Tomashefski, JF, Felo JA. The pulmonary pathology of illicit drug and substance abuse. 2004;10(5):413-26.
82. C.K. Hoffman, and P.C. Goodman Pulmonary edema in cocaine smokers Radiology 172 1989 463 465
83. H.F. Chambers, D.L. Morris, and M.G. Tauber Cocaine use and the risk for endocarditis in intravenous drug users Ann Intern Med 106 6 1987 833 836
84. R.B. Rubin, and J. Neugarten Cocaine-induced rhabdomyolysis masquerading as myocardial ischemia Am J Med 86 5 1989 551 553
85. J.Z. D'Amore, F. Gallahue, and S. Shetty Comparison of CPK-MB and troponin I in the evaluation of cocaine chest pain Acad Emerg Med 7 5 2000 442
86. D. Brookoff, E.A. Campbell, and L.M. Shaw The underreporting of cocaine-related trauma: drug abuse warning network reports vs hospital toxicology tests Am J Public Health 83 3 1993 369 371
87. D.L. Coleman, T.F. Ross, and J.L. Naughton Myocardial ischemia and infarction related to recreational cocaine use West J Med 136 5 1982 444 446
88. J.E. Hollander, K.H. Todd, and G. Green Chest pain associated with cocaine: an assessment of prevalence in suburban and urban emergency departments Ann Emerg Med 26 6 1995 671 676
89. A.I. Qureshi, M.F.K. Suri, and L.R. Guterman Cocaine use and the likelihood of nonfatal myocardial infarction and stroke Circulation 103 2001 502 506
90. S. Carley, and B. Ali Toward evidence based emergency medicine: best BETs from the Manchester Royal 4-175 Infirmary. Acute myocardial infarction in cocaine induced chest pain presenting as an emergency Emerg Med J 20 2 2003 174 175
91. M.C. Kontos, K.L. Schmidt, and C.S. Nicholson Myocardial perfusion imaging with technetium-99m sestamibi in patients with cocaine-associated chest pain Ann Emerg Med 33 6 1999 639 645
92. J.A. Feldman, S.S. Fish, and J.R. Beshansky Acute cardiac ischemia in patients with cocaine-associated complaints: results of a multicenter trial Ann Emerg Med 36 5 2000 469 476
93. T.O. Cheng Risk of acute myocardial infarction in cocaine abusers Circulation 101 2000 e227
94. J.E. Weber, F.S. Shofer, and L. Larkin Validation of a brief observation period for patients with cocaine-associated chest pain N Engl J Med 348 6 2003 510 517
95. J.E. Weber, C.R. Chudnofsky, and M. Boczar Cocaine-associated chest pain: how common is myocardial infarction? Acad Emerg Med 7 2000 873 877
96. M.A. Mittleman, D. Mintzer, and M. Maclure Triggering of myocardial infarction by cocaine Circulation 99 21 1999 2737 2741
97. M.J. Gitter, S.R. Goldsmith, and D.N. Dunbar Cocaine and chest pain: clinical features and outcome of patients hospitalized to rule out myocardial infarction Ann Intern Med 115 1991 277 282
98. J.L. Zimmerman, R.P. Dellinger, and P.A. Majid Cocaine-associated chest pain Ann Emerg Med 20 6 1991 611 615
99. G.F. Tokarski, P. Paganussi, and R. Urbanski An evaluation of cocaine-induced chest pain Ann Emerg Med 19 10 1990 1088 1092
100. J.E. Hollander, M. Lozano, and P. Fairweather "Abnormal" electrocardiograms in patients with cocaine-associated chest pain are due to "normal" variants J Emerg Med 12 2 1994 199 205
101. J.R. Brubacher, and R.S. Hoffman Cocaine toxicity Top Emerg Med 19 4 1997 1 16
102. F.L. Counselman, E.W. McLaughlin, and E.M. Kardon Creatine phosphokinase elevation in patients presenting to the emergency department with cocaine-related complaints Am J Emerg Med 15 1997 221 223
103. M. McLaurin, F.S. Apple, and T.D. Henry Cardiac troponin I and T concentrations in patients with cocaine-associated chest pain Ann Clin Biochem 33 1996 183 186
104. J.E. Hollander, A. Levitt, and G.P. Young Effect of recent cocaine use on the specificity of cardiac markers for diagnosis of acute myocardial infarction Am Heart J 135 1998 245 252
105. M.C. Kontos, P. Anderson, and J.P. Ornato Utility of troponin I in patients with cocaine-associated chest pain Acad Emerg Med 9 10 2002 1007 1013
106. J.A. Feldman, L.D. Bui, and P.M. Mitchell The evaluation of cocaine-induced chest pain with acute myocardial perfusion imaging Acad Emerg Med 6 2 1999 103 109
107. W.H. Dribben, M.A. Kirk, and J.A. Trippi A pilot study to assess the safety of dobutamine stress echocardiography in the emergency department evaluation of cocaine-associated chest pain Ann Emerg Med 38 1 2001 42 48
108. L. Littman, R.F. Miller, and M.H. Monroe Stress testing in patients with cocaine-associated chest pain J Emerg Med 27 4 2004 417 418
109. M.M. Guinn, J.A. Bedford, and M.C. Wilson Antagonism of intravenous cocaine lethality in nonhuman primates Clin Toxicol 16 1980 499 508
110. J.D. Catravas, and I.W. Waters Acute cocaine intoxication in the conscious dog: studies on the mechanism of lethality J Pharmacol Exp Ther 217 1981 350 356
111. B.M. Baumann, J. Perrone, and S.E. Hornig Randomized, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes Acad Emerg Med 7 2000 878 885
112. W.C. Brogan, R.A. Lange, and A.S. Kim Alleviation of cocaine-induced coronary vasoconstriction by nitroglycerin J Am Coll Cardiol 18 2 1991 581 586
113. J.E. Hollander, R.S. Hoffman, and P. Gennis Nitroglyerin in the treatment of cocaine associated chest pain - clinical safety and efficacy J Toxicol Clin Toxicol 32 3 1994 243 256
114. T. Honderick, D. Williams, and D. Seaberg A prospective, randomized, controlled trial of benzodiazepines and nitroglycerin or nitroglycerin alone in the treatment of cocaine-associated acute coronary syndromes Am J Emerg Med 21 1 2003 39 42
115. T.E. Albertson, A. Dawson, and F. de Latorre Tox-ACLS: toxicologic-oriented advanced cardiac life support Ann Emerg Med 37 4 2001 S78 S90
116. C.W. Schindler, S.R. Tella, and S.R. Goldberg Adrenoceptor mechanisms in the cardiovascular effects of cocaine in conscious squirrel monkeys Life Sci 51 9 1992 653 660
117. J.E. Hollander, W.A. Carter, and R.S. Hoffman Use of phentolamine for cocaine-induced myocardial ischemia N Engl J Med 327 5 1992 361
118. R. Trouve, and G. Nahas Nitrendipine: an antidote to cardiac and lethal toxicity of cocaine Proc Soc Exp Biol Med 183 3 1986 392 397
119. R. Trouve, G.G. Nahas, and W.M. Manger Catecholamines, cocaine toxicity, and their antidotes in the rat Proc Soc Exp Biol Med 196 2 1991 184 187
120. R.W. Derlet, and T.E. Albertson Potentiation of cocaine toxicity with calcium channel blockers Am J Emerg Med 7 5 1989 464 468
121. K.B. Keller, and L. Lemberg The cocaine-abused heart Am J Crit Care 12 6 2003 562 566
122. I.C. Sand, S.L. Brody, and K.D. Wrenn Experience with esmolol for the treatment of cocaine-associated cardiovascular complications Am J Emerg Med 9 2 1991 161 163
123. H.S. Bush Cocaine-associated myocardial infarction: a word of caution about thrombolytic therapy Chest 94 4 1988 878
124. F. LoVecchio, and L. Nelson Intraventricular bleeding after the use of thrombolytics in a cocaine user Am J Emerg Med 14 7 1996 663 664
125. J.E. Hollander, L.D. Wilson, and P.J. Leo Complications from the use of thrombolytic agents in patients with cocaine associated chest pain J Emerg Med 14 6 1996 731 736
126. K.S. Boniface, and J.A. Feldman Thrombolytic therapy and cocaine-associated acute myocardial infarction Am J Emerg Med 18 5 2000 612 615
127. R.S. Hoffman Thrombolytic therapy and cocaine-induced myocardial infarction [editorial] Am J Emerg Med 14 7 1996 693 695
128. S. Chakko, and R.J. Myerburg Cardiac complications of cocaine abuse Clin Cardiol 18 1995 67 72
129. K.J. Beckman, R.B. Parker, and R.J. Hariman Hemodynamic and electrophysiological actions of cocaine. Effects of sodium bicarbonate as an antidote in dogs Circulation 83 5 1991 1799 1807
130. J.M. Isner, N.A. Estes, and P.D. Thompson Acute cardiac events temporally related to cocaine abuse N Engl J Med 315 23 1986 1438 1443
131. R.W. Derlet, T.E. Albertson, and R.S. Tharratt Lidocaine potentiation of cocaine toxicity Ann Emerg Med 20 2 1991 135 138
132. R.D. Shih, J.E. Hollander, and J.L. Burstein Clinical safety of lidocaine in patients with cocaine-associated myocardial infarction Ann Emerg Med 26 6 1995 702 706
133. J.W. Hoekstra, W.B. Gibler, and R.C. Levy Emergency-department diagnosis of acute myocardial infarction and ischemia: a cost analysis of two diagnostic protocols Acad Emerg Med 1 2 1994 103 110
134. W.B. Gibler, J.P. Runyon, and R.C. Levy A rapid diagnostic and treatment center for patients with chest pain in the emergency department Ann Emerg Med 25 1 1995 1 8
135. M.E. Farkouh, P.A. Smars, and G.S. Reeder A clinical trial of a chest-pain observation unit for patients with unstable angina. Chest pain evaluation in the emergency room (CHEER) Investigators N Engl J Med 339 26 1998 1882 1888
136. S.O. Kushman, A.B. Storrow, and T. Liu Cocaine-associated chest pai in a chest pain center Am J Cardiol 85 2000 394 396