A 36-year-old man comes to the emergency department because of nausea and shortness of breath that started 1 hour ago. He also reports lightheadedness that started earlier in the day. He has type 2 diabetes mellitus, for which he takes metformin and sitagliptin. He has smoked 1 pack of cigarettes daily for 20 years. Temperature is 38.1 C (100.6 F), blood pressure is 180/106 mm Hg in the right arm and 182/104 mm Hg in the left arm, pulse is 110/min, and respirations are 20/min. Physical examination shows bilaterally dilated pupils, normal heart and lung sounds, and a nontender abdomen. ECG shows sinus tachycardia with ST-segment depression in the precordial leads. Cardiac enzymes are normal. Sublingual nitroglycerin and benzodiazepine therapy relieve the symptoms. Which of the following is the most likely cause of this patient's chest pain?

Question

A 36-year-old man comes to the emergency department because of nausea and shortness of breath that started 1 hour ago. He also reports lightheadedness that started earlier in the day. He has type 2 diabetes mellitus, for which he takes metformin and sitagliptin. He has smoked 1 pack of cigarettes daily for 20 years.   Temperature is 38.1 C (100.6 F), blood pressure is 180/106 mm Hg in the right arm and 182/104 mm Hg in the left arm, pulse is 110/min, and respirations are 20/min.  Physical examination shows bilaterally dilated pupils, normal heart and lung sounds, and a nontender abdomen.  ECG shows sinus tachycardia with ST-segment depression in the precordial leads. Cardiac enzymes are normal.  Sublingual nitroglycerin and benzodiazepine therapy relieve the symptoms.  Which of the following is the most likely cause of this patient's chest pain?

Quizplus · Accepted Answer

Eductional Objective: Cocaine intoxication causes increased sympathetic activity, which may be recognized by agitation, dilated pupils, tachycardia, and hypertension.  Cocaine-induced chest pain typically results from myocardial oxygen supply-demand mismatch (ie, myocardial ischemia) in the setting of coronary artery vasoconstriction.  Sublingual nitroglycerin and benzodiazepines help improve the myocardial ischemia and relieve the chest pain.

A 36-Year-Old Man Comes to the Emergency Department Because of Nausea