The prognosis is variable, depending on the extent of cardiac involvement. If the patient continues to drink, the prognosis is particularly grave. In one study, patients who remained abstinent over a
4-year period experienced a 9% mortality rate, whereas of those who continued to drink, 50% died during the same 4 years. Unfortunately, the recovery rate with abstinence is not as great as previously reported; earlier studies probably observed and reported cases of milder cardiac involvement. Only a minority of patients with moderate-to-severe alcoholic cardiomyopathy show clinical improvement with abstinence; after a certain stage of disease, the prognosis most likely continues to be poor, regardless of abstinence or therapy.
How common is cocaine use in the United States? Why is it important in cardiac problems?
An estimated 8 million people regularly use cocaine in the United States by inhalation, smoking, or intravenous injection. Recent surveys show that the number of hard-core cocaine users has increased. The mean age of hard-core cocaine users is rising as addicts age. Older or aging cocaine users experience a higher incidence of cardiac abnormalities.
How is cocaine use diagnosed as the cause of a specific cardiac problem?
All patients presenting with coronary artery disease syndrome, cardiac arrhythmias, myocardial dysfunction, myocarditis, or endocarditis should be questioned about use of cocaine and other drugs. The age, gender, and social status of the patient are not determining factors; grandmothers, stockbrokers, and all sorts of people use illicit drugs. Patients should be examined for marks from intravenous use, nasal redness, nasal septum irritation, or other physical signs of use. Urine should be analyzed for metabolites of cocaine if there is a concern, as it remains positive for 1-2 or sometimes several days, whereas plasma half-life is approximately 50-90 minutes.