From: Reuters
Published March 17, 2008 05:46 PM

Doctors urged to ask heart patients about cocaine

By Will Dunham

WASHINGTON (Reuters) - Two standard heart attack treatments can be dangerous for people who have used cocaine, and certain patients with chest pain should be asked if they have used the drug, a leading medical group said on Monday.

Younger patients and those without obvious heart disease risk factors should be asked when they arrive at hospital emergency rooms if they have used cocaine, the American Heart Association said in a statement in its journal Circulation.

Clot-busting drugs and beta-blockers -- treatments often given to patients who have suffered a heart attack -- can be perilous for cocaine users, the group said.

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Dr. James McCord, who headed the panel that drafted the statement, said there has been a significant increase in recent years in cocaine-related visits to U.S. emergency rooms. He said cocaine can trigger a heart attack or make one worse.

"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," said McCord, cardiology director of the chest pain unit for the Henry Ford Health System in Detroit.

Heart attacks are less common under age 45. Standard heart disease risk factors include high cholesterol, high blood pressure, diabetes, smoking, obesity and an unhealthful diet.

Cocaine boosts the heart's need for oxygen by increasing the heart rate, blood pressure and the heart's squeezing power with each beat, the group said. But the drug also deprives the heart of oxygen by constricting blood vessels and making the blood more likely to clot and cause a heart attack.

Chest pain known as angina is a symptom of the heart being deprived of oxygen.

A common way to diagnose and treat some heart attacks is threading a tiny tube into the heart's arteries and using imaging to pinpoint the location of a blockage. The artery can then be opened with a balloon.

When that cannot be done, patients with an apparent heart attack often get a clot-busting drug. But the statement noted that such drugs bring an extra risk of bleeding into the brain in patients whose blood pressure is high due to cocaine use.

Beta-blockers can lower blood pressure without constricting the arteries of heart attack patients, but could have the opposite effect in cocaine users -- raising blood pressure and squeezing arteries, according to the statement. In laboratory animals, this has led to seizures and death.

(Editing by Maggie Fox)

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