When to consider cocaine as a cause for a cardiac syndrome:
(1) history or laboratory evidence of cocaine use
(2) unexplained symptoms or signs of heart failure
(3) unexplained global or focal myocardial dyskinesia on echocardiogram
(4) acute coronary syndrome in a patient with angiographically normal coronary arteries
(5) sudden death in a young adult
The occurrence of unexplained heart disease in a young person might trigger consideration of cocaine use sooner than in an older person, where abuse of cocaine might go unrecognized.
The differential diagnosis in a young person includes quite a few conditions, so that age alone should not be the sole criteria for diagnosis:
(1) coronary artery vasospasm (angiographically normal coronary arteries)
(2) cardiomyopathy
(3) anomalous coronary artery
(4) vasculitis
Once the diagnosis has been introduced, a workup might include:
(1) hair analysis for drugs
(2) a more aggressive drug history with the patient
(3) discrete inquiries of family and friends
(4) drug screening at the time of presentation with another episode of heart disease
