Natural Health

Is It A Heart Attack Or Is It Cocaine

By: Drucilla Dyess
Published: Sunday, 23 March 2008
drug abuse

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According to new guidelines published on Monday, March 17th, in the American Heart Association (AHA) journal Circulation, patients without heart disease risk factors should be asked, upon arrival to hospital emergency rooms, if they have used cocaine. Cocaine use can cause young or otherwise healthy patients to complain of chest pain. The honesty of a patient can be a matter of life or death since some heart attack treatments can be deadly to cocaine users.

Dr. James McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit, headed the panel that outlined the AHA statement. According to McCord, "More commonly, these are younger people. The most common age group is about 35 to 44 for patients who come to the emergency department after cocaine use, having chest pain." He also said that there has been a significant increase in recent years of cocaine-related visits to U.S. emergency rooms and that cocaine could set off a heart attack or make one more severe.

Identifying the cause of the heart attack symptoms is especially important since two standard heart attack treatments can be extremely dangerous for people who have used cocaine. Clot-busting drugs and beta-blockers are treatments often given to patients who have suffered a heart attack.

Recent cocaine use causes increased blood pressure and can increase the risk of bleeding into the brain when a patient is given clot-busting drugs. Under normal circumstances, beta-blockers can lower blood pressure without constricting the arteries of typical heart attack patients. However, the treatment can cause opposite effects of higher blood pressure and constricted arteries in people who have used cocaine.

Another issue for cocaine users involves the use of stents, which prop open arteries to help restore blood flow to the heart. The AHA guidelines stated that long-term cocaine users with coronary artery blockage should receive bare-metal stents instead of drug-emitting stents. People with a long history of cocaine use may not follow schedules for taking medications for preventing drug-emitting stents from becoming blocked.

Heart disease risk factors include high cholesterol, high blood pressure, diabetes, smoking, obesity and an unhealthful diet. Heart attacks are less common under age 45. However, cocaine boosts the heart's need for oxygen as it increases the heart rate, blood pressure and the heart's squeezing power with each beat. In addition, cocaine deprives the heart of oxygen by constricting blood vessels and making the blood more likely to clot and cause a heart attack. Chest pain is a symptom of the heart being deprived of oxygen. Cocaine can also cause shortness of breath, anxiety, palpitations, dizziness, nausea and heavy sweating, which are all symptoms of a heart attack.

Per McCord, research shows that chest pain related to cocaine use usually occurs within three hours of use, but the chemical remnants can remain in the body for a minimum of 18 hours, which can continue to cause problems. He also noted that from 1999-2002, emergency room visits related to cocaine use increased by 47 percent and that people between the ages of 35-44 account for 37 percent of all cocaine-related emergency room visits.

The AHA statement recommends that cocaine users with chest pain should be monitored in an observation unit for nine to 12 hours since most chest pain associated with cocaine is not a heart attack. About 1-6 percent of patients with cocaine-associated chest pain actually have a heart attack. "If the patients are alert and can talk to you, typically you want to tell them, 'Look, it is important for us to know if you are taking cocaine because it could change the way we treat you,'" McCord said. "If a patient is unconscious, a drug test could be done at the physician's discretion."

Placing patients in an observation unit also allows the opportunity for healthcare providers to offer drug-cessation counseling. "Currently, the level of drug counseling available in most observation units, particularly at night, amounts to a pamphlet on drug abuse and referral phone numbers. This is an area where we can do a better job," McCord said. "We should use that hospital visit as a teachable moment to educate these patients on how they can improve their health and offer them counseling and referral programs for drug cessation."