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Routinely administering supplemental oxygen to all patients with chest pain could be a mistake, clinicians argued.

Case in point: a man in his 60s with coronary artery disease presented with chest pain and was taken by paramedics to a hospital's emergency department. Even though it was established that his oxygen saturation exceeded 95%, healthcare providers .

The patient only stopped getting oxygen 2 days after cardiac catheterization for what was found to be an ST-segment elevation MI [STEMI]. Thereafter, he experienced recurrent episodes of nonsustained ventricular tachycardia and atrial fibrillation requiring amiodarone (Cordarone) infusion; a decreased left ventricular ejection fraction was still apparent 6 weeks later.

"For our patient, it is possible that some of his episodes of nonsustained ventricular tachycardia and atrial fibrillation were, in part, related to the unnecessary oxygen that he received," according to , and , both of McGill University Heath Centre in Montreal, Canada, who shared the case in JAMA Internal Medicine.

"[T]he common practice of keeping oxygen 'for comfort' in nonhypoxic patients is questionable," they wrote, suggesting that supplemental oxygen in some cases is "too much of a good thing."

In an , , of Long Island Jewish Medical Center, N.Y., pointed to physiologic studies linking supplemental oxygen with increased coronary vascular resistance and a reduction in coronary blood flow. "Supplemental oxygen is associated with the development of reactive oxygen species that increase oxidative stress and can directly be arrhythmogenic," he wrote.

And paring back on oxygen use may have other advantages as well.

With supplemental oxygen costing around $12 per hour, Fitterman suggested: "Assuming an uncomplicated 2-day stay for a STEMI, of which the first 24 hours utilized oxygen therapy ... multiplied by the 340,000 STEMIs per year results in an annual cost to the US health system of almost $98 million dollars."

"In New York state that could purchase the silver plan on the health exchange for over 21,000 families," he noted.