Cocaine Use and the Risk for Endocarditis in Intravenous Drug Users

Chambers, Henry F.; Dl, Morris; Täuber, Martin G.; Modin, Gunnard

doi:10.7326/0003-4819-106-6-833

Cited by 157 publications

(51 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A large variety of cardiovascular diseases have been associated with cocaine use, including acute myocardial ischemia and infarction," [4][5][6][7][8][9][10][11][12] arrhythmias and sudden death,l-3 contraction bands,13 myocarditis,1415 cardiomyopathy,'6-18 hypertension,19 ruptured aorta,20 cerebrovascular aneurysm,2' accelerated atherosclerosis522 and endocarditis. 23 The purpose of the following review is to clarify the effects of an acute cocaine dose on the heart both in experimental animals and in humans and to compare this with the effects the drug may have when used chronically. Pharmacology…”

Section: U Clinical Progress Seriesmentioning

confidence: 99%

The effects of acute and chronic cocaine use on the heart.

et al. 1992

View full text Add to dashboard Cite

It is clear that cocaine has cardiotoxic effects. Acute doses of cocaine suppress myocardial contractility, reduce coronary caliber and coronary blood flow, induce electrical abnormalities in the heart, and in conscious preparations increase heart rate and blood pressure. These effects will decrease myocardial oxygen supply and may increase demand (if heart rate and blood pressure rise). Thus, myocardial ischemia and/or infarction may occur, the latter leading to large areas of confluent necrosis. Increased platelet aggregability may contribute to ischemia and/or infarction. Young patients who present with acute myocardial infarction, especially without other risk factors, should be questioned regarding use of cocaine. As recently pointed out by Cregler, cocaine is a new and sometimes unrecognized risk factor for heart disease. Acute depression of LV function by cocaine may lead to the presence of a transient cardiomyopathic presentation. Chronic cocaine use can lead to the above problems as well as to acceleration of atherosclerosis. Direct toxic effects on the myocardium have been suggested, including scattered foci of myocyte necrosis (and in some but not all studies, contraction band necrosis), myocarditis, and foci of myocyte fibrosis. These abnormalities may lead to cases of cardiomyopathy. Left ventricular hypertrophy associated with chronic cocaine recently has been described. Arrhythmias and sudden death may be observed in acute or chronic use of cocaine. Miscellaneous cardiovascular abnormalities include ruptured aorta and endocarditis. Most of the cardiac toxicity with cocaine can be traced to two basic mechanisms: one is its ability to block sodium channels, leading to a local anesthetic or membrane-stabilizing effect; the second is its ability to block reuptake of catecholamines in the presynaptic neurons in the central and peripheral nervous system, resulting in increased sympathetic output and increased catecholamines. Other potential mechanisms of cocaine cardiotoxicity include a possible direct calcium effect leading to contraction of vessels and contraction bands in myocytes, hypersensitivity, and increased platelet aggregation (which may be related to increased catecholamine). The correct therapy for cocaine cardiotoxicity is not known. Calcium blockers, alpha-blockers, nitrates, and thrombolytic therapy show some promise for acute toxicity. Beta-Blockade is controversial and may worsen coronary blood flow. In patients who develop cardiomyopathy, the usual therapy for this entity is appropriate.

show abstract

Section: U Clinical Progress Seriesmentioning

confidence: 99%

The effects of acute and chronic cocaine use on the heart.

et al. 1992

View full text Add to dashboard Cite

show abstract

“…These findings mirror those found by Toyoda et al [1] characteristics of the formulation that increases the risk of developing IE. This is a common theme in studies regarding IDUaIE and similar questions were left unanswered in the study by Chambers et al [5].…”

Section: Resultsmentioning

confidence: 99%

“…The authors suspect that usage patterns, differences in bacterial flora, or a more direct effect of cocaine itself could be responsible for the reported association. Of these possibilities, it is unlikely that cocaine's stimulant effects would be the sole reason for the association because amphetamine showed no association, with only two of the 23 (9%) IVDUs with endocarditis having used amphetamines and 35 of 92 (38%) of those without endocarditis used amphetamines [5]. Usage patterns could certainly be a contributing factor since cocaine injection generally occurs more frequently than heroin injection; cocaine's short duration of effect, local anesthetic and psychomotor stimulant properties result in it being injected more frequently and frenetically [6].…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

A Systematic Review of the Association between Individual Drugs Injected Intravenously and the Development of Infective Endocarditis

Serhan¹,

Silverman²

2017

J Addict Res Ther

View full text Add to dashboard Cite

Issues: Infective endocarditis (IE) is a relatively rare disease that is associated with a significant amount of morbidity and mortality. Injection drug use associated IE is increasing in incidence, warranting a better understanding of how the drug of choice impacts the development of IE. Many studies have drawn connections between certain drugs injected intravenously and the development of IE but none have rigorously evaluated why a particular drug might predispose persons who inject drugs (PWID) to IE. Approach:The PubMed database was thoroughly searched using combinations of various key words. Human studies with 20 cases or more of injection drug use associated IE that reported on the drugs injected were analyzed and included in this review. Key findings:No specific drug convincingly showed a strong association between its intravenous use and the development of IE, with studies having contradictory findings. The array of findings reported in the reviewed studies are more likely to be due to the frequency of use of particular drugs and their availability in the respective regions of study than the actual physiologic or pharmacologic properties of the drug. Implications:One trend that requires further investigation is the recent surge in opioid injection that has been linked to increased IE hospitalizations in several studies. Conclusion:Future research should aim to better understand how the preparation and/or physical properties of specific drugs may play a role in the development of IE.

show abstract

“…In the central nervous system, strokes (Levine et al, 1991) seizures (Dhuna et al, 1991), and movement disorders (Hegarty et al, 1991) can occur in first-time users, as well as seasoned addicts who have never experienced any cocaine-related complications in the past. Cocaine-induced cardiac problems are numerous, including arrhythmia (Benchimol et al, 1978), endocarditis (Chambers et al, 1987), myocardial infarction (Isner et al, 1986), cardiomyopathy (Om et al, 1992), and ruptured aorta (Barth et al, 1986).…”

Section: Medical Consequences Of Cocaine Usementioning

confidence: 99%

Metabotropic Glutamate Receptor 5 in the Medial Prefrontal Cortex: Role in Cocaine Sensitization and Addiction

Timmer¹

View full text Add to dashboard Cite

AcknowledgementsI would like to thank my advisor, Dr. Jeff Steketee, for his guidance and support throughout this process, as well as my outstanding committee, Drs. Matthew Ennis, Kristin Hamre, Rennolds Ostrom, and Wen Lin Sun for their input, suggestions, and evaluation. I am thankful for my lab buddy, Kyle Summers, for his exceptional conversation and collaboration on the self-administration project, and former post-doc Kun "Luke" Liu for teaching me microdialysis. I would like to thank my husband, Steve, for existing, as I could not have been this happy spending my life with anyone else. Last but absolutely not least, I would like to thank my children, Jack and Cassidy, for motivating me to complete this work.iv AbstractCocaine sensitization is associated with cocaine-induced hyperexcitability of pyramidal projection neurons within the medial prefrontal cortex (mPFC). Such hyperexcitability presumably results in increased glutamatergic input to reward-affiliated brain regions such as the ventral tegemental area (VTA) and nucleus accumbens (NAc), consequently facilitating drug-seeking behavior. Metabotropic glutamate receptor 5 (mGluR5) has been implicated in cocaine addiction and demonstrated to increase neuronal excitability, therefore, the aim of the present study was to investigate the effect of intra-mPFC mGluR5 manipulation on behavioral and neurochemical sensitization and drug-seeking. Bilateral cannulae were implanted into the mPFC of male Sprague-Dawley rats and mGluR5 antagonist MTEP (15 nmol/side) or saline was microinjected into the region five minutes prior to a challenge cocaine injection. Our data showed that intramPFC mGluR5 blockade via MTEP prevented late, but not early, behavioral sensitization. Further, intra-mPFC mGluR5 activation via DHPG (30 uM) increased mPFC and NAc glutamate levels in sensitized animals during early and late withdrawal, respectively. Finally, we observed a nonsignificant trend toward an MTEP-induced reduction in drug-seeking following the presentation of a cocaine-associated cue in animals that had been trained to self-administer cocaine. Taken together, our data suggest mPFC mGluR5 plays a role in cocaine addiction, possibly through the modulation of mPFC pyramidal neuronal excitability.

show abstract

Cocaine Use and the Risk for Endocarditis in Intravenous Drug Users

Cited by 157 publications

References 5 publications

The effects of acute and chronic cocaine use on the heart.

The effects of acute and chronic cocaine use on the heart.

A Systematic Review of the Association between Individual Drugs Injected Intravenously and the Development of Infective Endocarditis

Metabotropic Glutamate Receptor 5 in the Medial Prefrontal Cortex: Role in Cocaine Sensitization and Addiction

Contact Info

Product

Resources

About