Cocaine and Vasospasm

2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…Coronary injection of cocaine produces vasoconstriction in miniswine with experimentally induced nonocclusive atherosclerotic lesions. 865 Nademanee et al 866 performed 24-h ECG monitoring in 21 male cocaine users after admission to a substance abuse treatment center and found that 8 had frequent episodes of ST-segment elevation, most during the first 2 weeks of withdrawal. In cocaine users with prolonged myocardial ischemia, coronary arteriography can reveal coronary artery spasm with otherwise normal-appearing coronary arteries or with underlying minimally obstructive coronary atherosclerosis.…”

2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction

“…Coronary injection of cocaine produces vasoconstriction in miniswine with experimentally induced nonocclusive atherosclerotic lesions. 1009 Nademanee et al 1010 performed 24-h ECG monitoring in 21 male cocaine users after admission to a substance abuse treatment center and found that 8 had frequent episodes of ST-segment elevation, most during the first 2 weeks of withdrawal. In cocaine users with prolonged myocardial ischemia, coronary arteriography can reveal coronary artery spasm with otherwise normal-appearing coronary arteries or with underlying minimally obstructive coronary atherosclerosis.…”

Cocaine-associated central retinal artery occlusion in a young man

“…Inhibition of noradrenaline re-uptake by adrenergic nerve endings, direct vasoconstriction of vascular smooth muscle 7 and increased platelet aggregation 8 are Eye among the invoked mechanisms of cocaine-related vascular complications. Systemically cocaine results in increased vascular tone, increased heart rate and blood pressure, and increased myocardial contractility.…”

“…Myocardial infarctions in young adults after cocaine use have been attributed to vascular spasm and the dramatic increase in sympathetic tone. 2 Arterial spasm may be induced by cocaine 7 and may thus result in decreased ocular perfusion. In addition it is possible that severe hypertension from cocaine use could also have led to CRAO by causing fibrinoid necrosis within the vessels or haemorrhage under an atheromatous plaque within the central retinal artery.…”