Crack causes deadly heart condition    BBC   added 11/20/01

Crack cocaine may cause a deadly heart condition in which the walls of a major artery are ripped apart, research suggests. The condition, called aortic dissection, is the one which hospitalised Liverpool football manager Gerard Houllier last month. Aortic dissection occurs when the lining of the aorta - the major blood vessel that carries blood from the heart - tears, exposing the second layer. Cocaine use causes an extraordinary outpouring of stress hormones that can cause blood pressure to quickly rise. This may tear the lining of the vessel, called the intima. As the vessel pulses, the inner lining starts to peel away.

Researcher Dr Ann Bolger, of the University of California at San Francisco, said: "Nurses and physicians must be suspicious and ask about cocaine use and exposure. "Patients aren't always anxious to mention drug use, but a history of cocaine use should raise a flag."  An early diagnosis is imperative. Within the first 24 hours of a dissection of the aorta close to the heart, 25% of patients die. By 48 hours, half die. The symptoms of aortic dissection usually start with chest and back pain and often are mistaken for a heart attack. Aortic dissection usually occurs in older people who have high blood pressure and may also occur as a result of a congenital disorder called Marfan syndrome. The study was undertaken when researchers noticed cases of aortic dissection in younger people who did not have the usual risk factors, but admitted to habitual crack cocaine use.

The average age of the cocaine users was 42 - some 18 years younger than the non-cocaine users. Twenty-nine percent of those in the study who had used cocaine died as a result of aortic dissection, compared to 17% of the non-cocaine users. The research was presented at a meeting of the American Heart Association.