CMC Cases- Dr. Reyner

Cocaine Chest Pain

·      Cocaine is the 2nd most commonly used illicit drug in the US, 2nd to marijuana
·      Incidence of cocaine associated MI is 0.6 – 7%
·      Cocaine users have a lifetime risk of non fatal MI that is 7x the risk of non-users

·      Pathophysiology of cardiotoxicity:
       - Sympathomimetic, alpha adrenergic agonist, and prothrombotic

·      2008 AHA Guidelines:
       - All patients get ASA and BDZs (Class IC and IB recommendation)
       - STEMI: Unequivocally undergo cardiac catheterization
       - NSTEMI/ACS: Manage similar to non cocaine chest pain patients except avoid B blockers
       - Low-Moderate Risk: Observe in CPU for 9-12h. 
       - Based on data from a prospective study in 2003, NEJM, Weber et al.  
       - Always think of the patient’s cardiac risk factors independent of cocaine use to determine their risk. 

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Eczema Herpeticum

·      History: described as painful and burning. 
·      Patients at risk are those with underlying dermatoses, chronic immunosuppression
·      PE: Umbilicated pustules that progress to punched-out erosions
·      Usually have a recent HSV -1 exposure
·      Look for eye involvement: herpes keratitis
·      Treatment: oral acyclovir 400 mg PO tid
·      May need admission if having severe pain

Pill Esophagitis

·      History:
       - Retrosternal pain (60%), odynophagia (50%), and dysphagia (40%)

·      Common Causes:
       - Antibiotics: Doxycycline, Tetracycline and Clindamycin
       - Anti Inflammatory: ASA, NSAIDs
       - Bisphosphonates
       - Other Causes: Iron, Quinidine, KCl