Document Detail

Management of cocaine-induced cardiac arrhythmias due to cardiac ion channel dysfunction.
MedLine Citation:
PMID:  18815938     Owner:  NLM     Status:  MEDLINE    
Cocaine use is common in many areas of the world, particularly the United States and Western Europe. Toxicity following the use of cocaine is associated with a wide range of clinical features. In this review, we will focus on the cocaine-associated cardiac arrhythmias and, in particular, some of the controversies in their etiology and management. Cocaine can produce arrhythmias either through the production of myocardial ischemia or as a direct result of ion channel alterations. Excessive catecholamines, combined with sodium and potassium channel blockades, give rise to a wide variety of supra-ventricular and ventricular rhythms. The animal and human evidence for ion channel dysfunction is reviewed, and the effects of catecholamines are followed from the cardiac action potential to the development of arrhythmias. Finally, theoretical constructs are combined with existing evidence to develop a rational treatment strategy for patients with cocaine-induced cardiac arrhythmias. In particular, we review the evidence concerning the controversies relating to the use of lidocaine in comparison with sodium bicarbonate, in terms of QRS prolongation secondary to sodium channel blockade.
David M Wood; Paul I Dargan; Robert S Hoffman
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  47     ISSN:  1556-9519     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-20     Completed Date:  2009-02-09     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  14-23     Citation Subset:  AIM; IM    
Guy's and St Thomas' Poisons Unit, Guy's and St Thomas NHS Foundation Trust, London, UK.
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MeSH Terms
Action Potentials / drug effects
Anti-Arrhythmia Agents / administration & dosage,  adverse effects,  therapeutic use*
Arrhythmias, Cardiac / chemically induced,  drug therapy*,  metabolism
Cocaine / adverse effects*
Cocaine-Related Disorders / complications,  epidemiology,  metabolism*
Lidocaine / administration & dosage,  adverse effects,  therapeutic use
Long QT Syndrome / chemically induced,  drug therapy,  metabolism
Myocardium / metabolism
Potassium Channels / metabolism*
Sodium Bicarbonate / administration & dosage,  adverse effects,  therapeutic use
Sodium Channels / metabolism*
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/Potassium Channels; 0/Sodium Channels; 137-58-6/Lidocaine; 144-55-8/Sodium Bicarbonate; 50-36-2/Cocaine

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