LETTER
Heart Attacks, Smoking, and the Nicotine Patch
H.P. Kafka, MD
1 September 1994 | Volume 121 Issue 5 | Page 389
TO THE EDITOR:
In a recent letter, Drs. Warner and Little [1] described a patient who had a myocardial infarction while smoking and wearing a nicotine patch. The problem with this patient was not that he was wearing a nicotine patch but rather that he was smoking.
Patients of mine have had myocardial infarctions while smoking, including one who could induce angina by lighting a cigarette. I wager that many more patients in North America have had infarctions while smoking and not wearing a nicotine patch than while wearing a nicotine patch. I am also not convinced that this event occurred because of its temporal proximity to the patient's first myocardial infarction. A plaque rupture could have occurred at any time under similar stresses. Therefore, all patients (not only those who have had a previous myocardial infarction) should be warned not to smoke while wearing the nicotine patch. In fact, all patients should be warned not to smoke at all.
1. Warner JG, Little WC. Myocardial infarction in a patient who smoked while wearing a nicotine patch (Letter). Ann Intern Med. 1994; 120:695.
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