Chest pain and drug use?,”Pupillary dilation and blood at the external nares in a patient with chest pain can be a clue to a cocaine-induced vasospasm. ST elevation myocardial infarctions can occur as a consequence of cocaine use. Treat as other STEMIs, but beta-blockers should be avoided
as it allows for unopposed alpha agonist activity that can worsen vasospasm. Calcium channel blockers and alpha blockers can also help reduce vasospasm in these patients.”