[Diary/Dairy]

http://news.yahoo.com/s/ap/20080318/...2cq3ojQWms0NUE

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.

[Diary/Dairy]

We had a few cardiac arrests at my old job from cocaine use - but I did not know that clot busters and beta blockers were contraindicated when someone had used cocaine. Intersting.

[angel337]

"do you use any illegal drugs" is a routine question in the ER for young people with chest pain. it is a known fact that cocaine can cause cardiac damage. usually the ckmb is elevated. i see this quite often.

[TazziRN]

This has long been known to ER/ICU folks. It not only can cause symptoms of MI, it can cause an MI.

[Diary/Dairy]

I guess what I wanted to note was that Metoprolol and clot busters will make things worse. I too knew that cocaine would bring about an MI or arrest.

[sirI]

In the cocaine pt:

The use of thrombolytics carries a huge risk for cerebral hemorrhage.

Beta blockers can cause severe hypertension and coronary artery constriction.

[Angie O'Plasty, RN]

Although I knew that coke use could cause chest pain and/or MI, I had no idea that BB's and thrombolytics were contraindicated.

What about Nitro? Does it help or hurt?

What about crack? Isn't that a form of cocaine? So if someone's been smoking it, they're at the same level of risk, I assume.

[sirI]

quote=Angie O'Plasty, RN;2721018]Although I knew that coke use could cause chest pain and/or MI, I had no idea that BB's and thrombolytics were contraindicated.

What about Nitro? Does it help or hurt?

Yes, it helps, once MI is dx, utilize oxygen, ASA, nitro, benzos and phentolamine.

What about crack? Isn't that a form of cocaine? So if someone's been smoking it, they're at the same level of risk, I assume.

Yes, it is a form. And, same level of risk - even more so (same as IV) for the onset is almost instantaneous leading to vasoconstriction and myocardial ischemia due to decreased oxygenation.

[Miami NightNurse]

Thank You all for the info. I added it to the Cardiac Handbook I wrote. Wow learn something new every day!!!!! Can't believe as long as I've worked in Cardiovascular I didn't know that. Then again I've never had a fresh Cocaine MI, The ones we have had, have always been in such bad shape they went to ICU.

[sirI]

Originally Posted by Miami NightNurse

Thank You all for the info. I added it to the Cardiac Handbook I wrote. Wow learn something new every day!!!!! Can't believe as long as I've worked in Cardiovascular I didn't know that. Then again I've never had a fresh Cocaine MI, The ones we have had, have always been in such bad shape they went to ICU.

You're welcome.

You'll find the majority (not all) cocaine-related MIs have low mortality rates, too. The benzos and oxygen do a great job managing chest pain in most all pts. (that I've seen).