Answer:
Cocaine use can absolutely be associated with ischemic chest pain. Patients presenting with chest pain after cocaine may be considered for treatment per the Cardiac Ischemia Medical Directive.
Cocaine causes myocardial ischemia in a multifactorial fashion that includes: (1) increasing myocardial oxygen demand by increasing heart rate, blood pressure, and contractility; (2) decreasing oxygen supply via vasoconstriction; (3) inducing a prothrombotic state by stimulating platelet activation and (4) accelerating atherosclerosis.
McCord J, et al; American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Management of cocaine-associated chest pain and myocardial infarction: a scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation. 2008 Apr 8;117(14):1897-907. doi: 10.1161/CIRCULATIONAHA.107.188950. Epub 2008 Mar 17. PMID: 18347214.