COCAINE.
What do an Eric Clapton song and
the movie "Scarface" have
in common? Kids of the 60s will probably be
able to answer this one right off the bat: cocaine. Now, after
you get done singing
a few bars of the song or picturing the scene of Al Pacino cleaning
off his desk with his nose, come back to reality and remember
that this fashionable drug of the 70s is not all glamour. Now
replaced by ecstasy, crack and crystal methanphodime, cocaine's
popularity has faded, but never gone away.
Snorting, shooting or smoking, there are many forms and ways to
use cocaine, and we should never forget the seriousness of this
chemical. It may not get the media attention it once did, but
the danger is still there. The addiction is one of the most difficult
to recover from and the ramifications can have life-long implications,
particularly to the heart. Let's look more closely at cocaine;
the use, where it came from and how it affects the heart.
What is cocaine? Cocaine is an illegal
and highly addictive drug that is an extract from the coca plant.
Its use dates back more
than 5,000 years to South America, but reports of addiction have
been cited in the United States since the early 1900s.
In the 1970s, the United States government highly regulated its
medical use. At present, it is still used medically as a topical
anesthetic primarily in ENT (Ear, Nose and Throat) procedures.
Due to the social and legal stigma associated with its medical
use, many physicians have found other anesthetics to be just as
effective.
How does it work? Cocaine is found
in many forms. Medically, it has been applied topically and is
rapidly absorbed into the body
through the skin or mucous membranes, providing local anesthesia
and constricting of the blood vessels in the area applied. This
has implications when used by other means.
In terms of drug abuse, cocaine may be found in powder form and
is inhaled through the nose. It may also be heated and then smoked
in a form called freebasing or crack. Crack is very concentrated
and the most potent form of cocaine. Drug abusers may also inject
cocaine directly into the veins, which yields a very rapid absorption.
The onset of the action of the drug varies depending on the route
of administration. Inhalation and injection have an instantaneous
onset of action, with peak effects occurring within an hour or
two. This can have serious medical implications.
How does cocaine affect the heart? Cocaine
can cause very serious damage to the heart. It is important that
health care providers
consider the possible use of cocaine in young patients that present
with cardiac symptoms such as chest pain or heart arrhythmias.
Since cocaine causes blood vessels to constrict, the same happens
on the surface of the heart. These cardiac vessels can be affected,
interrupting the blood flow to the heart muscle. The symptoms
are the same as a heart attack.
It has also be shown that cocaine can cause clotting of the blood
and this will also lead to the blockage of the arteries on the
heart. Once again, this is the same process of a heart attack,
also called a myocardial infarction.
Lastly, recent literature has also shown that cocaine can lead
to atherosclerosis, which is narrowing of the arteries. In addition,
the heart muscle may be damaged leading to an enlarged heart.
What is the treatment for cocaine-induced chest pain? The
emergency treatment is the same for all chest pain or acute coronary
syndromes.
This may include the administration of aspirin, nitroglycerin
and blood thinning agents like heparin.
Beta blocking drugs are used in the treatment of acute coronary
syndrome, but if this is secondary to cocaine, they should not
be used. These drugs potentiate the effects of cocaine. This is
very dangerous and it is important to be honest with the health
care provider regarding the use of cocaine. In this instance,
benzodiazapines like Valium, Versed or Ativan will be used to
calm the effects of cocaine.
Additional treatment of cocaine-induced chest pain will probably
include hospitalization for cardiac monitoring. It may be necessary
to undergo cardiac catheterization as well to evaluate the status
of the coronary arteries.
What else should be done? Cocaine,
in all forms, is highly addictive. If you use cocaine, you must
stop! Seek help from a drug treatment
program. In the event that you develop cocaine-induced chest pain,
seek medical attention immediately and be honest with the health
care provider about your drug use, so that you will not be harmed
by medications that should not be given.
