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Chest Pain May Signal Cocaine Use in Young Patients

Cocaine use can sometimes be the hidden culprit when young or otherwise healthy patients complain to doctors of chest pain, according to a new scientific statement released Monday by the American Heart Association (AHA).

Physicians need to query patients as to whether they may have used the drug in such cases, the experts said.

For patients with a suspected heart attack, doctors need to rule out cocaine use because exposure to the drug can affect their treatment, committee chair Dr. James McCord, cardiology director of the chest pain unit of the Henry Ford Medical System in Detroit, said in a prepared statement. He noted that two standard heart attack treatments — beta-blockers and clot-busting drugs — can be dangerous if a patient has been using cocaine.

Increased blood pressure due to recent cocaine use can increase the risk of bleeding into the brain when a patient is given clot-busting drugs, the experts explained. Normally, beta-blockers can lower blood pressure without constricting the arteries of typical heart attack patients. But beta-blockers can have the opposite effects — higher blood pressure and constricted arteries — in people who've used cocaine.

While research shows that cocaine-related chest pain tends to occur within three hours of using the drug, the chemical remnants of cocaine can remain in the body for at least 18 hours and continue to cause problems, said McCord, who noted that between 1999 and 2002, cocaine-related emergency department visits increased by 47 percent. People ages 35-44 account for 37 percent of all cocaine-related visits to emergency departments, he added.

Since most cocaine-associated chest pain is not a heart attack, cocaine users with chest pain should be monitored in an observation unit for nine to 12 hours, the statement recommends.

"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."

While patients are in an observation unit, there's also an 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."

The new AHA statement also addresses the issue of stents, which are used to prop open arteries in order to help restore blood flow to the heart. Long-term cocaine users with a coronary artery blockage should receive bare-metal stents instead of drug-eluting [emitting] stents. That's because people with a long history of cocaine use may not adhere to schedules for taking medications aimed at preventing drug-eluting stents from becoming blocked, the statement says.

The statement was published in the journal Circulation.

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