Are heart attack symptoms due to cocaine use?
Treatments can be life-threatening if not known
Has your patient used cocaine? Not knowing the answer to this question could be life-threatening for your patient because the wrong medications might be given, says a new report on management of cocaine-associated chest pain and myocardial infarction.1
ED visits related to cocaine use increased 47% from 135,711 visits in 1995 to 199,198 visits in 2002, according to the Substance Abuse and Mental Health Services Administration.
Cocaine use can cause chest pain, shortness of breath, anxiety, palpitations, dizziness, and nausea, which all are symptoms suggesting a possible heart attack. However, some medications can be life-threatening if your patient has used cocaine, warns James McCord, MD, who chaired the statement writing committee for the report.
"The therapy would be different if it is known that the patient consumed cocaine," says McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit. "The ED nurse should question young patients with a traumatic chest pain and few cardiac risk factors about the use of cocaine."
If cocaine use is missed, therapy for typical ischemic heart disease and acute coronary syndromes, such as beta-blockers, can have detrimental or fatal consequences, says James Reiffel, MD, professor of clinical medicine at New York Presbyterian Hospital/Columbia University Medical Center in New York City.
Giving beta-blockers to a patient who has taken cocaine can lead to less blood flow to the heart, worsening hypertension, and even death, says Reiffel. "Cocaine use may induce coronary artery spasm and arrhythmias," he explains. "Beta blockade may protect against arrhythmias but may make the coronary spasm worse."
For patients who are hypertensive and tachycardic after cocaine use, benzodiazepines can be very effective. "These are not normally used if the patient has not taken cocaine," says McCord.
Reference
- McCord J, Jneid H, Hollander JE, et al. Management of cocaine-associated chest pain and myocardial infarction: A scientific statement from the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation 2008; 177:1,897-1,907.
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