MONDAY, March 11, 2002 (HealthDayNews) -- People who use crack cocaine face a significant risk of a deadly tear in the lining of their heart's main artery.
Doctors report the condition, known as aortic dissection, is common among inner-city crack cocaine users -- a result of the severe stress the drug use places on their heart. The condition causes severe chest pain and poses a significant risk of death if not diagnosed and treated promptly.
The researchers hope their findings will help other doctors to recognize the condition and cocaine's link to it, especially in urban, uninsured populations.
"Aortic dissection is usually caused by things like high blood pressure in older people," says lead investigator Dr. Priscilla Y. Hsue, a cardiology fellow at San Francisco General Hospital.
However, she and her colleagues noticed many young people were showing up in their emergency room with the problem. "They did admit to using cocaine, in particular crack cocaine," she says, and adds that most were also smokers.
When Hsue turned to existing medical studies of aortic dissection, she found cocaine wasn't recognized as a risk factor or cause of the condition. The team decided to conduct their own study, which appears in the April 2 issue of Circulation, but was released early.
The team examined hospital records of patients with aortic dissection from 1981 to 2000, and collected information on each patient's socioeconomic status, cocaine use and coronary risk factors.
Of the 38 cases Hsue and her team identified, 37 percent were linked to cocaine use. The patients were generally younger, smokers and more likely to be black.
Among the cocaine users, 71 percent showed signs of thickening of the heart wall and 79 percent had high blood pressure. While many had been prescribed medications to lower their hypertension, 64 percent of those patients weren't taking the drugs.
Compared to patients with aortic dissection who did not use cocaine, the in-hospital death rate among cocaine users with aortic dissection nearly doubled, to 29 percent.
"In our population, cocaine use in the setting of acute aortic dissection was relatively common," Hsue says. "It happened in more than one-third of patients, and the interval of cocaine use to the onset of symptoms was about 12 hours, although one patient developed chest pain while smoking crack cocaine."
"Cocaine causes systemic changes within the body," Hsue explains. "It causes higher blood pressure and higher heart rate through the release of stress hormones. It also increases the contractility of the heart." Together, these effects increase the risk of aortic dissection, particularly in those who already suffer from high blood pressure.
Dr. Roman W. Desanctis, senior author of an accompanying editorial in Circulation, says nearly 65,000 people come to U.S. emergency rooms nearly every year with chest pains related to cocaine.
Desanctis, a former director of clinical cardiology at Massachusetts General Hospital in Boston, says aortic dissection is not always considered by physicians when a patient comes to the emergency department with these symptoms. However, this latest study should change how doctors treat these people.
"A small number of those will have a dissection, but it's a very important group to identify because it's treatable if it's diagnosed soon enough and appropriate therapy is undertaken," Desanctis says.
Making sure doctors recognize aortic dissection is crucial, Hsue says. The researchers point out untreated patients face a 35 percent risk of death within the first 24 hours. However, the risk rises to 50 percent within 48 hours.
"In an urban-type population, it's something that health-care providers should be aware of and should think about when the right patient presents in an emergency room," Hsue says. "They should ask about drug use, and consider this condition."
Treatment for aortic dissection differs, depending on where the aorta rips. If it tears close to the heart, it must be treated by emergency surgery, while tears further from the heart can be treated with drugs that lower blood pressure, as well as beta-blockers. Desanctis notes there is some concern that when cocaine is involved, beta-blockers can actually cause spasms of the coronary artery.
Hsue and her team are continuing their studies of patients who come to their emergency room with aortic dissection.
What To Do: Find out more about the dangers of crack cocaine from the National Institute on Drug Abuse, the Texas Commission on Alcohol and Drug Abuse or the Partnership for a Drug-Free America.
