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Junior doctors in emergency and internal medicine seem to be aware of cocaine use as a risk factor for acute coronary syndrome, but when faced with a potential patient, they are less likely to ask about or record it than other risk factors.factors.
Of 34 residents and fellows given a case scenario of acute coronary syndrome, 31 were aware of cocaine as a risk factor but only 18 stated they routinely inquired, whereas nearly all claimed they inquired about other recognised risk factors. This failure was validated by referring to 156 records of consecutive patients with suspected or proved acute coronary syndrome and finding a record of use or non-use of cocaine in only eight. The pathophysiology, and hence the treatment, of acute coronary syndrome caused by cocaine is totally different from that caused by atheroma, so failure to inquire may result in inappropriate management.