Mar. 12, 2002 DALLAS, March 12 – Cocaine can cause a lethal tearing in the heart’s main artery, a condition that should be suspected in people treated for chest pain at urban hospitals, say researchers in today’s rapid access issue of Circulation: Journal of the American Heart Association. A preliminary report of the study was presented at the American Heart Association’s annual Scientific Sessions last November.
The condition called aortic dissection occurs when the lining of the aorta – the major blood vessel carrying blood from the heart – tears, exposing the inner layer. Cocaine use is not a commonly recognized risk factor for aortic dissection, which usually occurs in older people with high blood pressure. However, researchers at San Francisco General Hospital noticed younger patients coming to the hospital with aortic dissection due to cocaine use.
“Most patients came to the hospital with chest pain shortly after drug use, and one developed symptoms while smoking crack,” says primary researcher Priscilla Y. Hsue, M.D., division of cardiology, San Francisco General Hospital.
Cocaine use causes an increase in stress hormones that can cause blood pressure to quickly rise. This may tear the lining of the vessel, which can allow blood to enter and rip it even further, says Hsue. The dissection may stop blood from reaching critical organs, or even cause the aorta to rupture.
“In urban settings, aortic dissection should be considered when young people come to the emergency room with severe chest pain, especially if they have other risk factors like high blood pressure and smoking,” says Hsue. “It’s very important to get a rapid diagnosis. For untreated aortic dissection, the mortality rate can be as high as 35 percent within the first 24 hours. After 48 hours the death rate rises to about 50 percent.”
Researchers reviewed hospital charts from 1981-2001 looking for cases of aortic dissection. They recorded demographic information as well as information on cocaine use and coronary risk factors. Of the 38 cases found, 37 percent were related to cocaine use. Cocaine users were younger (average age of 41 vs. 59 in non-cocaine users), more likely to be African American, and all smoked cigarettes.
Hypertension had been diagnosed in 79 percent of the cocaine users, 71 percent had documented left ventricular hypertrophy (thickening of the heart wall), and at least 64 percent were not taking their prescribed anti-hypertensive medication.
Twenty-nine percent of the cocaine users died in the hospital, which was almost twice the death rate of the non-cocaine users.
Co-authors of the study include: Cynthia L. Salinas, M.D.; Ann F. Bolger, M.D.; Neal L. Benowitz, M.D.; and David D. Waters, M.D.
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