Heart attack or cocaine pain?

2008-03-18 14:18

Dallas - Younger ER patients with heart attack symptoms should be asked if they've recently used cocaine, which can cause similar chest pain, the American Heart Association warns doctors.

For these patients, honesty can be a matter of life or death: Some heart attack treatments can be deadly to someone using cocaine.

New guidelines published online on Monday in the American Heart Association journal Circulation say that emergency room doctors need to be aware that symptoms of a heart attack in younger patients with no heart disease risk factors may be caused by cocaine use.

The drug can cause chest pain, shortness of breath, anxiety, palpitations, dizziness, nausea and heavy sweating - all symptoms of a heart attack.

Could be deadly

"Not knowing what you are dealing with and giving the wrong therapies could mean death rather than benefit," said Dr James Reiffel, professor of clinical medicine at Columbia University Medical Centre/New York Presbyterian Hospital.

The number of cocaine-related users visiting ERs rose 47% from 1995 to 2002, increasing from 135 711 to 199 198, according to the government's Substance Abuse and Mental Health Services Administration. (That's a tiny percentage of the more than 100 million patient visits to emergency rooms each year.)

"The symptoms that they get with the cocaine are very similar to a heart attack," said Dr James McCord, who chaired the statement writing committee.

Cocaine can cause a heart attack, but only about one to six percent of patients with cocaine-associated chest pain actually have a heart attack, the statement says. Still, doctors say it's important for anyone with chest pain to get it checked out.

Cocaine increases blood pressure and the heart rate, constricting arteries into the heart, said McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit.

"Your heart rate goes up because your heart needs more oxygen, then it shrinks the arteries to the heart," McCord said.

Reiffel said doctors should explain why it's important to know if a patient is using cocaine. He said that admitting use of an illegal substance is confidential information that won't be reported to law enforcement. "The caregiver is not here to judge."

- AP