ER Chest Pains Could Signal Cocaine Use

Docs need to be aware of drug's symptoms to ensure proper treatment

SUNDAY, Oct. 14, 2001 (HealthDayNews) -- When a relatively young person shows up at an emergency room complaining of chest pains, doctors typically look first for the usual suspects, ranging from chest injury to panic attacks. But experts say they should also be looking for something far more ominous -- cocaine.

Cocaine use was, in fact, cited in 30 percent of all drug-related emergency department visits in the United States during 1999, according to a review article published in a recent issue of The New England Journal of Medicine.

Finding out whether cocaine is the culprit in an ER situation can be critical for another reason as well. Previous research has shown that administering beta blockers, the traditional treatment for chest pain, to patients suffering from cocaine-related chest pain can not only be ineffective, but also deadly.

"Cocaine causes the arteries to constrict, and if you use a beta blocker on patients who are taking cocaine, it can worsen the constriction of the blood vessel," says Dr. Richard Lange, a professor of medicine at the University of Texas Medical Center, Dallas, and author of the new study, as well as the previous research.

Although doctors usually give a possible combination of nitroglycerine and beta blocker to a patient with chest pains, Lange says those who are having cocaine-related pain should be given nitroglycerine and what's called a calcium channel blocker instead. <

There are a number of ways cocaine use is believed to trigger a heart attack, say experts: the drug can cause a sudden rise in blood pressure and heart rate, as well as contractions of the left ventricle (or pumping chamber) of the heart.

And you don't have to be a long-term user to be at risk, warns Lange.

"The scary thing is it can happen with first time use, or it can happen in people who have used for long periods of time," he says.

In fact, previous research has shown that during the first hour after using cocaine, the user's risk of heart attack increases almost 24 times.

Dr. Murray Mittleman, of the Institute for Prevention of Cardiovascular Disease at Beth Israel Deaconess Medical Center in Boston, and author of that research, says that the risk does come down about an hour or two after cocaine use.

But, he adds, the more a person uses cocaine, the greater the risk becomes.

"We know that even young, apparently healthy people can have heart attacks caused by cocaine use, and we know that each episode of cocaine use is associated with a transient increase in heart attack risk," Mittleman says.

In some cases, the risk of cocaine use is more than transient, and can even cause permanent damage, Mittleman explains.

"Aside from the arteries, the heart muscle itself can be damaged by repeated use of cocaine. It actually appears to cause scarring and could subsequently lead to other problems even after stopping use. So it can really lead to chronic problems," Mittleman adds.

Lange says the purpose of his review article was to raise more awareness among doctors of not just the prevalence of such cases, but the potential severity.

"If a young person, ranging from their teens up to their 30s, comes to an emergency room complaining of chest pain, and there aren't any risk factors for having a heart attack, most physicians wouldn't even consider the cocaine connection," Lange says.

"But since cocaine can actually precipitate a heart attack, we need to pay attention to young people who present with chest pain and inquire to see if that's a possibility," he adds.

Lange cites statistics from the National Institute on Drug Abuse that show, as of 1999, an estimated 25 million Americans admitted that they had used cocaine at least once; 3.7 million had used cocaine in the past year; and 1.5 million were current users.

Cocaine use is the leading cause of drug-related deaths in the United States.

What To Do

Visit the American Heart Association for more information on cocaine, marijuana and other drugs.

And you can read much more about the effects of cocaine abuse in the National Institute on Drug Abuse's report on Cocaine Abuse and Addiction.

SOURCES: Interviews with Richard Lange, M.D., professor of medicine, University of Texas Medical Center, Dallas; Murray A. Mittleman, M.D., Dr. P.H., Institute for Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston; press release, review article from Aug. 2 The New England Journal of Medicine
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