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Hollander and colleagues¹ found that among 129 patients who presented to emergency departments (EDs) during February 1996 with chest pain syndromes, cocaine use was documented by 1 or more physicians or nurses at a rate of only 13%. Other cardiac risk factors were documented more frequently: tobacco use, 90%; hypertension, 82%; family history of premature coronary disease, 77%; diabetes mellitus, 73%; and hypercholesterolemia, 58%. The authors emphasize that efforts to question patients about cocaine use more frequently are necessary since cocaine abuse is a common reason for visits to urban EDs for chest pain, and since recent use of cocaine may alter treatment and disposition.

Another risk factor for chest pain syndromes and coronary artery disease that is rarely mentioned in EDs by admitting team physicians or nurses is passive smoking (PS). While there are no published data to my knowledge regarding the incidence of chest pain induced by PS . . . [Full Text of this Article]

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