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Cocaine Abuse Presents Emergency Room Challenges

AHA statement offers guidance for diagnostic, therapeutic interventions in chest pain and myocardial infarction

TUESDAY, March 18 (HealthDay News) -- The management of cocaine-associated chest pain and myocardial infarction can be complex, according to a scientific statement published online March 17 in Circulation: Journal of the American Heart Association.

Jim McCord, M.D., of the American Heart Association Acute Cardiac Care Committee of the Clinical Cardiology Council, and colleagues conducted a comprehensive search of medical literature involving cocaine-associated chest pain and myocardial infarction.

Of all the illegal drugs, the researchers found that cocaine results in the most emergency department visits, with 175,000 such visits -- 40 percent of them involving chest discomfort -- occurring in the year 2000 alone. They recommend that patients with cocaine-associated chest pain, unstable angina or myocardial infarction be treated similarly to those with traditional acute coronary syndrome or possible acute coronary syndrome, but cited some notable exceptions.

"Unlike patients with acute coronary syndrome unrelated to cocaine use, cocaine users should be provided with intravenous benzodiazepines as early management. In the setting of cocaine use, benzodiazepines relieve chest pain and have beneficial cardiac hemodynamic effects. The neuropsychiatric symptoms and cardiovascular complications of cocaine use are interrelated; therefore, management of neuropsychiatric manifestations favorably impacts the systemic manifestations of cocaine toxicity," the authors write. "Cessation of cocaine use should be the primary goal of secondary prevention. Recurrent chest pain is less common and myocardial infarction and death are rare among patients who discontinue cocaine."

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