Cocaine-related deaths, drug-related emergency visits drastically increasing, UT Southwestern researchers report

DALLAS - Physicians should consider the possibility of cocaine use as a culprit when young adults are brought to emergency rooms for nontraumatic chest pains, according to researchers at the UT Southwestern Medical Center at Dallas.

Chest pain is the most common complaint of cocaine users, and in 1999 cocaine use was cited in 30 percent of all drug-related emergency department visits.

In a review article published in today's issue of The New England Journal of Medicine, Drs. Richard Lange and L. David Hillis report on the cardiovascular complications associated with cocaine use and effective treatments.

"Death from cocaine abuse is on the rise in the United States," said Hillis, who is vice chairman of internal medicine. "Early identification and understanding of cocaine-related cardiovascular complications are essential to their proper management."

Lange and Hillis suggest that emergency medical physicians consider cocaine use in young patients with conditions such as arrhythmias, heart attack, inflammation of the heart muscle or dilated cardiomyopathy, a heart defect characterized by increased thickness of the wall of the left ventricle.

In 1999 an estimated 25 million Americans admitted that they had used cocaine at least once; 3.7 million had used cocaine in the past year; and 1.5 million were current users.

In addition, medical examiners report that cocaine is the most frequent cause of drug-related deaths.

Both Lange and Hillis have published extensively and made novel observations regarding cocaine-related heart disease.

In 1990 the researchers reported that beta-blockers, which are commonly administered to patients with chest pain, were not only ineffective, but also detrimental in patients with cocaine-related chest pain.

In a 1991 study Hillis and Lange reported that nitroglycerin, which dilates and relaxes blood vessels, had a beneficial effect on patients with cocaine-related chest pains. In 1994 the researchers found that verapamil hydrochloride, a calcium blocker, alleviated cocaine-induced constricted blood vessels.

"Most cocaine-related chest pains are due to the fact that the blood vessels have been constricted," Hillis said. "The most effective treatment for this is nitroglycerin or calcium blockers."