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Emergency Medicine

Unusual Tachycardia After Cocaine Use

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1 Credit CME

JAMA Internal Medicine

Published Online: July 24, 2023

Challenges in Clinical Electrocardiography

Article Information and Disclosures

Mazen M. Kawji, MD^1,2

Author Affiliations

¹OSF Cardiovascular Institute, Peoria, Illinois
²Saint Elizabeth Hospital, Ottawa, Illinois

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A patient in their 20s presented to the emergency department complaining of severe midsternal chest pain of several hours’ duration. The patient was in very good health before their presentation. The patient was not taking any medications and had no risk factors for coronary artery disease. They used cocaine 3 to 4 hours before presentation. Physical examination showed that the patient was thin, anxious, and in acute distress. The patient was diaphoretic and tachypneic. Their blood pressure was 138/80 mm Hg with a regular pulse of 180 beats per minute; they did not have a fever. The patient had a questionable S₄, but otherwise their examination was unremarkable. An electrocardiogram (ECG) was conducted (Figure, A). The tachycardia spontaneously ended within 1 to 2 minutes, and a repeated ECG was obtained (Figure, B).

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A patient in their 20s presented to the emergency department complaining of severe midsternal chest pain of several hours’ duration. The patient was in very good health before their presentation. The patient was not taking any medications and had no risk factors for coronary artery disease. They used cocaine 3 to 4 hours before presentation. Physical examination showed that the patient was thin, anxious, and in acute distress. The patient was diaphoretic and tachypneic. Their blood pressure was 138/80 mm Hg with a regular pulse of 180 beats per minute; they did not have a fever. The patient had a questionable S₄, but otherwise their examination was unremarkable. An electrocardiogram (ECG) was conducted (Figure, A). The tachycardia spontaneously ended within 1 to 2 minutes, and a repeated ECG was obtained (Figure, B).

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Article Information

Corresponding Author: Mazen M. Kawji, MD, OSF Healthcare, 1050 E Norris Dr, Ste 1B, Ottawa, IL 61350 (muhamed.m.kawji@osfhealthcare.org).

Published Online: July 24, 2023. doi:10.1001/jamainternmed.2023.1737

Conflict of Interest Disclosures: None reported.

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AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.