What should be the management of patients with suspected cardiac complications of novel psychoactive substances? Is observation and supportive treatment sufficient?
Dan Perri: I think for the most part observing patients, looking for troponin elevation and electrocardiographic (ECG) abnormalities, and I would treat all of those as if they could be an underlying coronary disease syndrome. For the most part, without elevated troponin and without a significant ECG abnormality it is unlikely patients would need to go on to any therapy other than supportive care with fluids and benzodiazepines but they should be investigated as though their chest symptoms could in fact be cardiac in nature because these agents do have sympathomimetic effect. They can easily unmask a primary arrhythmia or a primary cardiac problem that as until that point had been undiagnosed.