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Cocaine and the Hearts

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Addiction Medicine FYI

Cocaine and the Heart

  • Cocaine accounts for more than 100,000 emergency room visits in the U.S. each year, with chest pain being one of the most common complaints seen in 40 percent of cocaine-related emergency room visits.
  • Long-term regular cocaine abuse impairs cardiac left ventricular function in African-Americans, according to research by Dr. Shenghan Lai and colleagues (American Journal of Cardiology 97(7):1085-1088, 2006).
    • Magnetic resonance imaging of heart muscle contractions disclosed lower pumping efficiency in areas of the left ventricular wall.
    • The findings suggest that prolonged exposure to the drug may cause sub-clinical impairments that increases risk for cardiac events.
  • Acute cocaine abuse has previously been associated with several cardiac complications, including driving up the blood pressure, increased heart rate, and increase contractility. It also has vasoconstrictive (vessel narrowing) effects on the coronary arteries and is associated with increased platelet activation and clotting.   Arrhythmia (an irregularity in the rhythm of the heartbeat), ruptured aorta, heart attack and sudden death have all been seen after cocaine use.
  • While the full pathological effects of cocaine are unknown, researchers believe a cocaine induced heart attack occurs soon after cocaine use, usually within the first few hours; although other studies suggest that, particularly in chronic users, ischemia or lack of oxygen to the tissues can occur many hours or even days after cocaine use.
  • Echocardiograms, EKG’s and serum creatine kinase values may show abnormal results because of cocaine use, so that these usual means of diagnosing a heart attack cannot be relied upon; cardiac biomarkers such as troponin can help diagnose cocaine associated heart attacks.
  • Benzodiazepines should be considered an initial treatment among patients with cocaine associated heart attacks because they can relieve the chest pain and improve blood pressure and heart rate.  Nitroglycerin can also be effective to relieve chest pain and reduce blood pressure.  Beta blockers may cause increased coronary narrowing (vasoconstriction) and should be avoided in cocaine associated heart attacks.