What is the role of ECG in the evaluation of cocaine toxicity?

Updated: Sep 01, 2018
  • Author: Lynn Barkley Burnett, MD, EdD, LLB(c); Chief Editor: Sage W Wiener, MD  more...
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Answer

Obtain a 12-lead electrocardiogram (ECG) in patients with any of the following:

  • Chest pain
  • Hypoxia
  • Dyspnea
  • An irregular, rapid, or slow pulse
  • Altered mental status
  • Moderate-to-severe toxicity

Of 48 patients admitted to an intensive care unit with cocaine-induced chest pain, 86% had abnormal ECG findings, but only 6% were found to have sustained a nyocardial infarction.

The Brugada sign has been noted in cocaine users. This finding should prompt consideration of its implications for sudden cardiac death. Note the images below.

Schematics show the 3 types of action potentials i Schematics show the 3 types of action potentials in the right ventricle: endocardial (End), mid myocardial (M), and epicardial (Epi). A, Normal situation on V2 ECG generated by transmural voltage gradients during the depolarization and repolarization phases of the action potentials. B-E, Different alterations of the epicardial action potential that produce the ECGs changes observed in patients with Brugada syndrome. Adapted from Antzelevitch, 2005.
Three types of ST-segment elevation in Brugada syn Three types of ST-segment elevation in Brugada syndrome, as shown in the precordial leads on ECG in the same patient at different times. Left panel shows a type 1 ECG pattern with pronounced elevation of the J point (arrow), a coved-type ST segment, and an inverted T wave in V1 and V2. The middle panel illustrates a type 2 pattern with a saddleback ST-segment elevated by >1 mm. The right panel shows a type 3 pattern in which the ST segment is elevated < 1 mm. According to a consensus report (Antzelevitch, 2005), the type 1 ECG pattern is diagnostic of Brugada syndrome. Modified from Wilde, 2002.

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