可卡因可以导致年轻患者胸口痛
Chest Pain May Signal Cocaine Use in Young PatientsMONDAY, March 17 (HealthDay News) -- Cocaine use can sometimes be the hidden culprit when young or otherwise healthy patients complain to doctors of chest pain, according to a new scientific statement released Monday by the American Heart Association (AHA).
Physicians need to query patients as to whether they may have used the drug in such cases, the experts said.
For patients with a suspected heart attack, doctors need to rule out cocaine use because exposure to the drug can affect their treatment, committee chair Dr. James McCord, cardiology director of the chest pain unit of the Henry Ford Medical System in Detroit, said in a prepared statement. He noted that two standard heart attack treatments -- beta-blockers and clot-busting drugs -- can be dangerous if a patient has been using cocaine.
Increased blood pressure due to recent cocaine use can increase the risk of bleeding into the brain when a patient is given clot-busting drugs, the experts explained. Normally, beta-blockers can lower blood pressure without constricting the arteries of typical heart attack patients. But beta-blockers can have the opposite effects -- higher blood pressure and constricted arteries -- in people who've used cocaine.
While research shows that cocaine-related chest pain tends to occur within three hours of using the drug, the chemical remnants of cocaine can remain in the body for at least 18 hours and continue to cause problems, said McCord, who noted that between 1999 and 2002, cocaine-related emergency department visits increased by 47 percent. People ages 35-44 account for 37 percent of all cocaine-related visits to emergency departments, he added.
Since most cocaine-associated chest pain is not a heart attack, cocaine users with chest pain should be monitored in an observation unit for nine to 12 hours, the statement recommends.
\"If the patients are alert and can talk to you, typically you want to tell them, 'Look, it is important for us to know if you are taking cocaine because it could change the way we treat you,'\" McCord said. \"If a patient is unconscious, a drug test could be done at the physician's discretion.\"
While patients are in an observation unit, there's also an opportunity for healthcare providers to offer drug-cessation counseling.
\"Currently, the level of drug counseling available in most observation units, particularly at night, amounts to a pamphlet on drug abuse and referral phone numbers. This is an area where we can do a better job,\" McCord said. \"We should use that hospital visit as a teachable moment to educate these patients on how they can improve their health and offer them counseling and referral programs for drug cessation.\"
The new AHA statement also addresses the issue of stents, which are used to prop open arteries in order to help restore blood flow to the heart. Long-term cocaine users with a coronary artery blockage should receive bare-metal stents instead of drug-eluting stents. That's because people with a long history of cocaine use may not adhere to schedules for taking medications aimed at preventing drug-eluting stents from becoming blocked, the statement says.
http://www.forbes.com/forbeslife/health/feeds/hscout/2008/03/17/hscout613616.html
星期一， 3月17日(HealthDay新闻) --当年轻人或健康患者向医生抱怨胸口痛时，应用可卡因可能就是暗藏的罪犯。根据美国心脏协会(AHA)星期一发表的一个新的科学声明中说。
内科医生需要询问患者否他们在胸口痛的情况下使用了可卡因药物，专家说。
对于一个被怀疑的心脏病发作的病人，医生需要排除应用了可卡因，因为暴露于可卡因时可能影响他们的治疗，在Henry Ford医疗系统的胸口痛单位的委员会主席心脏病学主任James McCord博士，在一个准备好的声明中说。 他注意到，二种标准应用于心脏病发作治疗药物 -- β阻断药和促凝血的药物 -- 如果患者同时用可卡因，是危险的。
由于近期使用可卡因，，当给患者给促凝血的药物时，在血压增高时可能增加脑子出血的风险，专家解释。 通常，在典型的心脏病发作患者β阻断药能低血压，无收缩动脉作用。 但是在用了可卡因的人β阻断药可能有相反作用 – 可以升高血压和收缩的动脉。
研究表明，与可卡因相关的胸口痛倾向于使用该药物三个小时内发生，可卡因代谢残余在身体可能保持至少18个小时，并且继续造成问题， McCord说，他注意到，在1999年和2002年之间，与可卡因相关的急诊门诊就诊人数增加了47%。年龄为35-44岁的人到门诊急诊就诊的有37%与可卡因相关，他补充说。
声明推荐既然多数可卡因伴生的胸口痛不是心脏病发作，伴有胸口痛的可卡因药物使用者应在在观察单位内被监测九个到12个小时。
“如果患者很警戒可卡因并且能与您谈话，您典型地想要告诉他们， ‘看，我们知道的您是否用可卡因是重要，因为它可能改变我们治疗您的方式’”， McCord说。 “如果患者是未意识到，医师应该谨慎进行药物测试”。
当患者是在观察单位时，也有给患者提供保健服务的一个机会即能提供药物停止建议。
“当前，对药物使用的水平建议可利用在多数观察单位，特别在晚上，共计在滥用毒品和推举电话号码的一个小册子。 这是我们可以把工作做的更好的区域”， McCord说。 “我们应该使用医院留观作为教育的时间关于这些患者他们怎样可以改进他们的健康和提供他们停止使用药物建议”。
新的AHA声明也论及stents（移植）的问题，即被用于为了帮助恢复血流到心脏移植开放动脉。冠状动脉阻塞并长期可卡因使用者应该接受光秃金属stents（移植）而不是药物洗脱的[散发的] stents。 那是，因为使用可卡因有一个悠久的历史的人可能不遵守采取的疗程而使得不能阻止药物洗脱stents使冠状动脉变得阻塞，声明说。
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{可卡因的药理学作用是阻断DAT, NET, SERT。 }
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