Cardiac complications of cocaine abuse

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Abstract

Cardiac complications of cocaine abuse and a rational approach to evaluating and managing them are described. Cardiac abnormalities reported among asymptomatic cocaine abusers include echocardiographic left ventricular hypertrophy and segmental wall motion abnormalities. Electrocardiogram may reveal increased QRS voltage. ST-T changes, and pathologic Q waves. Episodes of ST elevation may be seen during Holter monitoring. The management of cocaine-abusing patients who present to an emergency room with acute chest pain is controversial because the two reported studies yielded conflicting results regarding the incidence of myocardial infarction (MI). Even in the absence of infarction, electrocardiographic abnormalities are common among these patients, which complicates the decision-making regarding hospitalization. Pathophysiology of cocaine-related MI is discussed. Distinct clinical features of cocaine-related MI make it clear that the association between the two is not just temporal. However, considering the number of persons abusing cocaine, it is a rarity. Beta-adrenergic blockers should be avoided in the treatment of cocaine-induced myocardial ischemia which is best treated with nitrates and calcium-channel blockers. Reports of cocaine- induced myocarditis and cardiomyopathy are reviewed. Experimental studies and clinical case reports suggest that cocaine may cause lethal arrhythmias. Cocaine prolongs repolarization by a depressant effect on potassium current and may generate early after depolarizations. It is possible that cocaine- associated arrhythmias are secondary to vasospasm-related ischemia and reperfusion as well.

Original languageEnglish
Pages (from-to)67-72
Number of pages6
JournalClinical Cardiology
Volume18
Issue number2
StatePublished - Jan 1 1995

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Cocaine-Related Disorders
Cocaine
Myocardial Infarction
Cardiac Arrhythmias
Ambulatory Electrocardiography
Adrenergic beta-Antagonists
Myocarditis
Calcium Channel Blockers
Acute Pain
Left Ventricular Hypertrophy
Chest Pain
Cardiomyopathies
Nitrates
Infarction
Reperfusion
Myocardial Ischemia
Hospital Emergency Service
Decision Making
Potassium
Electrocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Cardiac complications of cocaine abuse. / Chakko, S.; Myerburg, Robert J.

In: Clinical Cardiology, Vol. 18, No. 2, 01.01.1995, p. 67-72.

Research output: Contribution to journalArticle

Chakko, S & Myerburg, RJ 1995, 'Cardiac complications of cocaine abuse', Clinical Cardiology, vol. 18, no. 2, pp. 67-72.
Chakko, S. ; Myerburg, Robert J. / Cardiac complications of cocaine abuse. In: Clinical Cardiology. 1995 ; Vol. 18, No. 2. pp. 67-72.
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