The cardiovascular effects of cocaine are multifactoral and complex. Cocaine has been shown to cause or to be associated with cardiomyopathy, myocarditis, endocarditis, ventricular arrhythmias, myocardial infarction, coronary artery spasm and angina, and sudden death. Cocaine inhibits the neuronal or presynapdc reuptake of norepinephrine and the neuronal uptake of catecholamine hormones. This pharmacologic action increases the synaptic cleft concentration of norepinephrine and the circulating levels of both norepinephrine and epinephrine.
Cardiovascular Complications of Cocaine
Acute myocardial infarction Chest pain without myocardial infarction Acute, reversible myocarditis Irreversible heart muscle disease Acute, severe hypertension Acute aortic dissection, rupture
Electrocardiographic changes: sinus tachycardia, premature ventricular complexes,
Wolff-Parkinson-White arrhythmias, ventricular tachycardia, torsade de pointes, ventricular fibrillation, prolongation of QTc, and early repolarization (ST segment) changes Pneumopericardium Stroke
Subarachnoid hemorrhage Accelerated coronary atherosclerosis Intimal hyperplasia of coronary vessels
From Crawley IS, Schlant RC: Effect of noncardiac drugs, electricity, poisons, and radiation on the heart. In Schlant RC, Alexander RW (eds): Hurst’s The Heart, 8th ed. New York, McGraw-Hill, 1994, with permission.
What is the most common clinical presentation in cocaine abuse?
Chest pain is the most common symptom, whereas acute myocardial infarction (MI) is the most common clinical presentation.
How does cocaine abuse cause an acute MI?
Cocaine affects the heart in multiple ways, both directly and indirectly. Cocaine abuse may result in myocardial infarction in patients with normal coronary arteries, coronary artery spasm, or previous coronary artery disease. The mechanisms include (1) increased oxygen demand (secondary to increases in heart rate and blood pressure), (2) decreased coronary artery blood flow (secondary to vasospasm or thrombosis with increased platelet aggregation), and (3) myocarditis (secondary to toxic effect or hypersensitivity). Cocaine use also promotes intimal proliferation in coronary arteries.