title: Myocardial ischemia during cocaine withdrawal.
abstract: OBJECTIVE
  To determine the prevalence of myocardial ischemia in patients with cocaine addiction.
  
  
  METHODS
  Myocardial ischemia in chronic cocaine users was detected by serial 24-hour electrocardiographic ambulatory (Holter) monitoring and exercise treadmill testing in chronic cocaine users. The Holter tapes were coded, scanned in a blinded manner, and mixed with the tapes of 42 normal volunteers and 119 patients with either stable or unstable angina.
  
  
  METHODS
  A 28-day inpatient, substance abuse treatment program followed by an outpatient treatment program.
  
  
  METHODS
  Twenty-one consecutive male chronic cocaine users.
  
  
  RESULTS
  Eight of the 21 patients with cocaine addiction had frequent episodes of ST elevation during Holter monitoring; these episodes occurred almost exclusively during the first 2 weeks of withdrawal. None of the volunteers and patients with stable angina and only 4% of the patients with unstable angina had episodes of ST elevation during Holter monitoring (cocaine users compared with volunteers, P = 0.0004). Of the 20 cocaine patients who had exercise treadmill testing, only 1 had a positive test for ischemia.
  
  
  CONCLUSIONS
  Cocaine users frequently develop silent myocardial ischemia manifesting as episodes of ST elevation during the first weeks of withdrawal. The underlying mechanisms for these changes remain unknown, but our observations support the hypothesis that coronary vasospasm plays an important role in cocaine-related ischemic syndromes.
authors.affiliation: West Los Angeles Veterans Administration Medical Center, California.
authors.forename: K
authors.initials: K
authors.lastname: Nademanee
authors.forename: D A
authors.initials: DA
authors.lastname: Gorelick
authors.forename: M A
authors.initials: MA
authors.lastname: Josephson
authors.forename: M A
authors.initials: MA
authors.lastname: Ryan
authors.forename: J N
authors.initials: JN
authors.lastname: Wilkins
authors.forename: H A
authors.initials: HA
authors.lastname: Robertson
authors.forename: F V
authors.initials: FV
authors.lastname: Mody
authors.forename: V
authors.initials: V
authors.lastname: Intarachot
mesh_terms: D000328:Adult; D003042:Cocaine / Q000009:adverse effects*; D003327:Coronary Disease / Q000139:chemically induced*; D003329:Coronary Vasospasm / Q000139:chemically induced; D004298:Dopamine / Q000172:deficiency; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005080:Exercise Test; D006801:Humans; D008297:Male; D011379:Prognosis; D013223:Statistics as Topic; D013375:Substance Withdrawal Syndrome
chemical_list: D003042:Cocaine; D004298:Dopamine