Document Detail

Cardiac complications of cocaine abuse.
MedLine Citation:
PMID:  7720292     Owner:  NLM     Status:  MEDLINE    
Cardiac complications of cocaine abuse and a rational approach to evaluating and managing them are described. Cardiac abnormalities reported among asymptomatic cocaine abusers include echocardiographic left ventricular hypertrophy and segmental wall motion abnormalities. Electrocardiogram may reveal increased QRS voltage, ST-T changes, and pathologic Q waves. Episodes of ST elevation may be seen during Holter monitoring. The management of cocaine-abusing patients who present to an emergency room with acute chest pain is controversial because the two reported studies yielded conflicting results regarding the incidence of myocardial infarction (MI). Even in the absence of infarction, electrocardiographic abnormalities are common among these patients, which complicates the decision-making regarding hospitalization. Pathophysiology of cocaine-related MI is discussed. Distinct clinical features of cocaine-related MI make it clear that the association between the two is not just temporal. However, considering the number of persons abusing cocaine, it is a rarity. Beta-adrenergic blockers should be avoided in the treatment of cocaine-induced myocardial ischemia which is best treated with nitrates and calcium-channel blockers. Reports of cocaine-induced myocarditis and cardiomyopathy are reviewed. Experimental studies and clinical case reports suggest that cocaine may cause lethal arrhythmias. Cocaine prolongs repolarization by a depressant effect on potassium current and may generate early afterdepolarizations. It is possible that cocaine-associated arrhythmias are secondary to vasospasm-related ischemia and reperfusion as well.
S Chakko; R J Myerburg
Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical cardiology     Volume:  18     ISSN:  0160-9289     ISO Abbreviation:  Clin Cardiol     Publication Date:  1995 Feb 
Date Detail:
Created Date:  1995-05-23     Completed Date:  1995-05-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  67-72     Citation Subset:  IM    
University of Miami School of Medicine, Florida, USA.
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MeSH Terms
Angina Pectoris / etiology
Arrhythmias, Cardiac / etiology
Heart Diseases / diagnosis,  etiology*
Myocardial Infarction / etiology
Substance-Related Disorders / complications*
Reg. No./Substance:

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