Left Main Coronary Artery and Femoral Artery Vasospasm Associated with Cocaine Use

Myers, Gary; Hansen, Torben; Jain, Avanindra

doi:10.1378/chest.100.1.257

Cited by 12 publications

(4 citation statements)

References 7 publications

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“…Ergene et al [3] reported two cases of catheter-induced vasospasm involving the right external iliac and femoral arteries during coronary angiography that were clearly catheter-induced in a patient with very tortuous iliac arteries. Spontaneous arterial vasospasm involving both coronary and peripheral vascular beds simultaneously has also been previously reported with cocaine usage [17]. However, this appears to be the first documented case of catheter-induced vasospasm of both coronary and peripheral vessels.…”

Section: Discussionsupporting

confidence: 60%

“…Proposed mechanisms include mechanical irritation triggering a myogenic reflex [6,7], stress receptor activation [8], and platelet aggregation at the catheter tip with release of vasoactive agents [9]. Several underlying etiologies have been documented including hypercholesterolemia, ergot toxicity, exercise, L-thyroxin therapy, hyperosmolar contrast medium, nonsteroidal anti-inflammatory drugs, cigarette smoking, and alcohol [7,8,[10][11][12][13][14][15][16][17][18]. In accordance with the presence of mild coronary artery disease (CAD) in the LAD and LCx in this patient, she also fits the typical prototype of patients predisposed to coronary vasospasm as previously defined by provocative testing with ergonovine [19].…”

Section: Discussionmentioning

confidence: 99%

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Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

Shortal

Mahmud

Tsimikas

2005

Int J Cardiovasc Imaging

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Catheter-induced vasospasm is well appreciated during diagnostic coronary angiography and angioplasty, but has rarely been described in peripheral arteries. We present an unusual case of concomitant catheter-induced vasospasm of the right external iliac and right coronary arteries. This case illustrates the potential challenges in diagnosing catheter-induced vasospasm from fixed obstructive atherosclerotic lesions in peripheral vessels.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

Shortal

Mahmud

Tsimikas

2005

Int J Cardiovasc Imaging

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“…Cocaine abuse is known to be associated with coronary artery vasospasm and has the potential to cause acute myocardial infarction. [1][2][3] Cocaine's vasospastic effects appear to be mediated by blockade of the presynaptic catecholamine reuptake, which, in turn, results in catecholaminergic surge at the postsynaptic receptor sites as well as sympathomimetic stimulation. The downstream effect causes activation of the alpha receptors, calcium flux into the vascular smooth muscle, and resultant coronary vasoconstriction.…”

Section: Introductionmentioning

confidence: 99%

Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

Lo¹,

Virk

Lakhter

et al. 2019

The American Journal of Medicine

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BACKGROUND: Recent guidelines have suggested avoiding beta-blockers in the setting of cocaine-associated acute coronary syndrome. However, the available evidence is both scarce and conflicted. The purpose of this systematic review and meta-analysis is to investigate the evidence pertaining to the use of betablockers in the setting of acute cocaine-related chest pain and its implication on clinical outcomes. METHODS: Electronic databases were systematically searched to identify literature relevant to patients with cocaine-associated chest pain who were treated with or without beta-blockers. We examined the endpoints of in-hospital all-cause mortality and myocardial infarction. Pooled risk ratios (RR) and their 95% confidence intervals (CI) were calculated for all outcomes using a random-effects model. RESULTS: Five studies with a total of 1447 patients were included. Our analyses found no differences between patients treated with or without beta-blockers for either myocardial infarction (RR 1.08; 95% CI, 0.61-1.91) or all-cause mortality (RR 0.75; 95% CI, 0.46-1.24). Heterogeneity among included studies was low to moderate. CONCLUSION: This systematic review and meta-analysis suggests that beta-blocker use is not associated with adverse clinical outcomes in patients presenting with acute chest pain related to cocaine use.

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“…Vascular spasm is a well-described mechanism of coronary occlusion, but its role in the pathogenesis of chronic cardiac diseases, including congestive heart failure (CHF) and dilated cardiomyopathy, has been debated for decades. Vascular spasm of the epicardial coronary arteries has been associated with cocaine use [3][4][5][6], connective tissue disease [7], and myocardial bridging of coronary arteries [8,9]. Coronary artery vascular spasm can appear unprovoked or may occur in the setting of a disrupted atherosclerotic plaque [10], and spasm may be provoked by percutaneous coronary artery interventions such as angioplasty, stenting, and vascular ultrasound [11,12].…”

Section: Vascular Tonementioning

confidence: 99%

The interaction of coronary tone and cardiac fibrosis

Wheeler

McNally

2005

Curr Atheroscler Rep

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Regulation of coronary vascular tone is critical for proper perfusion and function of the myocardium. Many disease processes result in compromised regulation of coronary vascular tone and impaired myocardial perfusion. A common result of coronary vascular dysfunction is the development of areas of replacement fibrosis within the myocardium and surrounding the vasculature. Both intravascular processes, such as coronary atherosclerosis and endothelial dysfunction, and extravascular processes, including compromised myocardial metabolism, hormone excesses, and altered local signaling, may result in coronary vascular dysregulation. Coronary occlusion events, in turn, lead to myocardial damage and the activation of inflammatory cells and fibroblasts. The role of fibroblasts in regulating myocardial fibrosis and the contribution of myofibroblasts, cells that have limited contractile potential while retaining many of the extracellular matrix regulating processes of the fibroblast, may also contribute to the development of myocardial disease. In this review we examine the recent literature on myocardial fibrosis and myofibroblast activity, highlighting the effects of several classes of cardiovascular agents on the remodeling process.

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Left Main Coronary Artery and Femoral Artery Vasospasm Associated with Cocaine Use

Cited by 12 publications

References 7 publications

Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

Catheter-induced Vasospasm of Both the Right External Iliac and Right Coronary Arteries During Coronary Angiography

Clinical Outcomes After Treatment of Cocaine-Induced Chest Pain with Beta-Blockers: A Systematic Review and Meta-Analysis

The interaction of coronary tone and cardiac fibrosis

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