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Cocaine-associated myocardial ischemia
LETTERS
TO THE EDITOR
COCAINE-ASSOCIATED
MYOCARDIAL
ISCHEMIA
have the usual risk factors should raise the suspicion of the possibility of coronary spasm related to recreational cocaine use [lo].
To the Editor: We read with intense interest the article by David W. Mathias, M.D. (Am J Med 1986; 81: 675-678) on cocaine-associated myocardial ischemia. This is certainly a most important topic; reader interest is enormous and cocaineassociated myocardial ischemia and infarction is a socially relevant issue. The author correctly points out that the incidence of cocaine use has increased in both adolescents and adults. He incorrectly states that some IO million Americans have tried cocaine at least once and one to two million are current users. These data were based on a 1979 report. More recent data published suggest that 22 to 30 million Americans have used cocaine and 5 million use it regularly [ 11. Of great concern is the nationwide trend of increased emergency room visits, admissions, and cocaine-related deaths. Cocaine use resulting in medical complications [2] is the rule rather than the exception. We previously published a report in which a young man had two myocardial infarctions with a temporal relation to cocaine use [3]. The time from cocaine ingestion to the onset of angina was documented in this case. Additional case reports not included in Dr. Mathias’ review have also been published [4-g]. We concur with the author’s statement that physicjans should inquire about cocaine use in patients with unexplained symptoms of myocardial ischemia. Acute myocardial infarction occurring in any young patient who does not
388
February
1987
The American Journal of Medicine
LOUIS L.
CREGLER,
HERBERT
Bronx Veterans
1.
6. 7.
a.
9. 10.
Volume 82
MARK,
M.D. M.D.
Administration Medical Center Mount Sinai School of Medicine New York, New York 10029
Abelson HI, Miller JD: A decade of trends in cocaine use in the household populations. Nat1 lnst Drug Abuse Res Monogr Ser 1985; 61: 35-49. Cregler LL, Mark H: Medical complications bf cocaine abuse. N Engl J Med 1986; 315: 1495-1500. Cregler LL, Mark H: Relation of acute myocardial infarction to cocaine abuse. Am J Cardiol 1985; 56: 794. Gould L, Gopalaswamy C, Pate1 C, Betzu R: Cpcaine-induced myocardial infarction. NY State J Med 1985; 85: 660. Wilkins CE, Mathur VS, Ty RC, Hall RJ: Myocardial infarction associated with cocaine abuse. Tex Heart lnst J 1985; 12: 385-387. Weiss RJ: Recurrent myocardial infarction caused by cocaine abuse. Am Heart J 1986; 111: 793. Simpson RW, Edwards WD: Pathogenesis of cocaine-induced ischemic heart disease. Arch Pathol Lab Med 1986; i IO: 479-484. Rollingher IM, Belzberg AS, Macdonald IL: Cocaine-induced myocardial infarction. Can Med Assoc J 1986; 135: 4546. Weiner RS, Lockhart JT, Schwartz RG: Dilated cardiomyopathy and cocaine abuse. Am J Med 1986; 81: 699-701. Cregler LL, Mark H: Cardiovascular dangers of cocaine abuse (editorial). .Am J Cardiol 1986; 57: 1185-l 186. Submitted
December
2, 1986, and accepted
December
10, 1986.
TO THE EDITOR
COCAINE-ASSOCIATED
MYOCARDIAL
ISCHEMIA
have the usual risk factors should raise the suspicion of the possibility of coronary spasm related to recreational cocaine use [lo].
To the Editor: We read with intense interest the article by David W. Mathias, M.D. (Am J Med 1986; 81: 675-678) on cocaine-associated myocardial ischemia. This is certainly a most important topic; reader interest is enormous and cocaineassociated myocardial ischemia and infarction is a socially relevant issue. The author correctly points out that the incidence of cocaine use has increased in both adolescents and adults. He incorrectly states that some IO million Americans have tried cocaine at least once and one to two million are current users. These data were based on a 1979 report. More recent data published suggest that 22 to 30 million Americans have used cocaine and 5 million use it regularly [ 11. Of great concern is the nationwide trend of increased emergency room visits, admissions, and cocaine-related deaths. Cocaine use resulting in medical complications [2] is the rule rather than the exception. We previously published a report in which a young man had two myocardial infarctions with a temporal relation to cocaine use [3]. The time from cocaine ingestion to the onset of angina was documented in this case. Additional case reports not included in Dr. Mathias’ review have also been published [4-g]. We concur with the author’s statement that physicjans should inquire about cocaine use in patients with unexplained symptoms of myocardial ischemia. Acute myocardial infarction occurring in any young patient who does not
388
February
1987
The American Journal of Medicine
LOUIS L.
CREGLER,
HERBERT
Bronx Veterans
1.
6. 7.
a.
9. 10.
Volume 82
MARK,
M.D. M.D.
Administration Medical Center Mount Sinai School of Medicine New York, New York 10029
Abelson HI, Miller JD: A decade of trends in cocaine use in the household populations. Nat1 lnst Drug Abuse Res Monogr Ser 1985; 61: 35-49. Cregler LL, Mark H: Medical complications bf cocaine abuse. N Engl J Med 1986; 315: 1495-1500. Cregler LL, Mark H: Relation of acute myocardial infarction to cocaine abuse. Am J Cardiol 1985; 56: 794. Gould L, Gopalaswamy C, Pate1 C, Betzu R: Cpcaine-induced myocardial infarction. NY State J Med 1985; 85: 660. Wilkins CE, Mathur VS, Ty RC, Hall RJ: Myocardial infarction associated with cocaine abuse. Tex Heart lnst J 1985; 12: 385-387. Weiss RJ: Recurrent myocardial infarction caused by cocaine abuse. Am Heart J 1986; 111: 793. Simpson RW, Edwards WD: Pathogenesis of cocaine-induced ischemic heart disease. Arch Pathol Lab Med 1986; i IO: 479-484. Rollingher IM, Belzberg AS, Macdonald IL: Cocaine-induced myocardial infarction. Can Med Assoc J 1986; 135: 4546. Weiner RS, Lockhart JT, Schwartz RG: Dilated cardiomyopathy and cocaine abuse. Am J Med 1986; 81: 699-701. Cregler LL, Mark H: Cardiovascular dangers of cocaine abuse (editorial). .Am J Cardiol 1986; 57: 1185-l 186. Submitted
December
2, 1986, and accepted
December
10, 1986.