CCU - Cocaine may cause symptoms of MI

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http://news.yahoo.com/s/ap/20080318/ap_on_he_me/cocaine_heart;_ylt=AjyY.PIQlAf0_Q2cq3ojQWms0NUE

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.

Specializes in Education, FP, LNC, Forensics, ED, OB.
Actually dude, the beta blockade causes alpha 1 domination throughout Tupac. This vasoconstriction from the alpha 1 agonism of the crack rock is already causing an increase in preload that slows the heart down (bainbridge reflex). Completely block out the stimulus for the heart to lub/dub (beta 1 receptors) and bang Tupac is now dead, or at least pushing for asystole. We occasionally push labetalol on these dudes because of its 7:1 ratio of alpha/beta antagonism. Really think that a vasodilator like nitro or nicardipine would be superior though.

Sorry.....not a dude.

Agree, bradycardia is initial and transient and rapidly followed by tachycardia and hypertension.

Labetalol has been used with cocaine-related MI, but it definitely is not recommended with myocardial ischemia. The beta-antagonistic effects are much more potent than the alpha-adrenergic effects and have shown to produce seizures and increased mortality rates. Verapamil (a negative inotrope) is a better choice in cocaine-related MIs, reducing heart rate.

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I don;t understand your references to Tupac either.......

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Specializes in Cardiac, ER.

I don;t understand your references to Tupac either.......

He was being funny,....:lol2:

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Specializes in Med-Surg.
I don;t understand your references to Tupac either.......

He was being funny,....:lol2:

Are you kidding me?!? I don't find that funny at all. His constant references to "Tupac" made his otherwise intelligent comment, sound like trash. Come on, drug use effects EVERYONE. What an ignorant thing for a nurse to say. I'm sure he provides non-judgemental, quality care to each of his patients.

It's upsetting that someone I could work beside may have that kind of attitude, it's scary that other people think it's funny. :stone

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I know - I could see that post coming from a certain group of people - Not sure I would want to work with them though - I mean, nursing is supposed to be a little more professional.....

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Specializes in CRNA.

I don't know dudette, if you are looking to treat a crack related MI usually caused by coronary vasoconstriction, a phenylakylamine like verapamil will slow the heart rate and allow for a longer diastolic coronary perfusion time, but it is not going to blow open and relieve the coronary spasm like a healthy dose of nicardipine will. Dihydropyrimidines have a much greater vasodilating effect than any of the CCBs, particularly in the coronaries. Farley would have appreciated it. That and a little naloxone.

Hell yeah I enjoy people like this that come in to the OR. Do I judge them? Not really. I just enjoy playing with all the toys and drugs that go into fixing them up until they can get their next fix on the street. It is a lot of fun and it makes my living hell aka school more pleasurable. Shem really summed this up well in his book. Law IV: The patient is the one with the disease. Basically, better them than me, but after sleeping all of these gomers, I know my day is coming.

This view might not fit what some are fed in nursing school, but it certainly does me well. I can even throw a little theory in to this. I do for the patient what they can not do for themselves (old lady Henderson) without any regard to their race, religion, sexual orientation, or lack of ambition to get a job. Work in a busy ED for a few years and your view of nursing might morph a little too:bugeyes:. Obama and Farrakhan would be so proud.:nurse:

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Greatly appreciate it if you'd not refer to me as dudette.

And, Verapamil is utilized for the tachycardia-related cocaine toxicity. Has absolutely nothing to do with initial brady-related early toxicity.

Not sure if you are taking this seriously, but if you are and just trying to add some humor into your posts, then o.k. If not, then maybe it would be a good thing to leave the humor out of the posts and refer to treatment (evidenced-based) for cocaine-related MIs.

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Specializes in Education, FP, LNC, Forensics, ED, OB.

March 19, 2008:

People admitted to the hospital with chest pain or myocardial infarction (MI) associated with cocaine use should be treated much the same as any other patient with "traditional" ACS, but with the addition of intravenous benzodiazepines and a cautionary approach to beta blockers...

Evidence also suggests that beta blockers should be avoided in the acute phase, given the propensity of some of these agents to worsen coronary artery vasoconstriction and increase blood pressure. Indeed, given the high number of cocaine users who continue to use the drug even after an MI, physicians may need to avoid beta blockers even for the long-term management of patients with coronary artery disease.

Benzodiazepines should be an initial treatment among patients with cocaine-associated MI because they can relieve chest pain and improve the hemodynamic profile. Nitroglycerin can also be effective to relieve chest pain and reduce blood pressure.

Immediate percutaneous coronary intervention remains the preferred treatment vs thrombolysis for patients with ST-segment-elevation, cocaine-associated MI. In fact, fibrinolysis might be even more dangerous among patients with a history of cocaine use vs those who do not use cocaine because of a higher risk for intracranial hemorrhage.

Read article in its entirety:

New Statement on Cocaine-Associated MI Urges Caution With Beta Blockers, Emphasizes Kicking the Habit

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