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

Abstract

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.

Cocaine and the Heart

“…There is still a debate as to whether the appearance of a mononuclear cell infiltrate is a secondary reaction to myocyte death or whether it represents a primary hypersensitivity reaction to cocaine, with a resultant myocarditis. 10 …”

Daño vascular asociado a uso de cocaína: Caso clínico

“…Principalmente debido a sus propiedades simpaticomiméticas, aumenta el consumo de oxígeno, produce taquicardia, eleva la presión arterial, aumenta la contractilidad miocárdica e induce vasoconstricción coronaria 9 . Sin embargo, los efectos vasomotores no explican por sí solos todas las complicaciones isquémicas observadas en estos pacientes, especialmente aquellas que ocurren en el largo plazo.…”

Pathophysiology and therapeutic targets for ischemic stroke

“…17 Illicit drugs such as cocaine and amphetamines have been implicated in both stroke and heart disease. 12,18 Elevated levels of homocysteine may be a factor in both disorders as well. 7,11 As is true of many chronic illnesses, genetics play a substantial role in both stroke and heart disease.…”