Cardiovascular manifestations of substance abuse part 1: cocaine.
Substance abuse with cocaine is associated with multiple cardiovascular conditions, including myocardial infarction, dissection, left ventricular hypertrophy, arrhythmias, sudden death, and cardiomyopathy. Cocaine has effects to potentiate the physiologic actions of catecholamines and has direct effects on voltage-dependent sodium ion channels related to local anesthetic properties. The effects of cocaine can be augmented with concomitant alcohol consumption. Acute myocardial ischemia caused by cocaine may be related to in situ thromboisis and/or coronary vasospasm. Treatment strategies for cocaine-induced myocardial infarction would include antiplatelet therapy, thrombolysis, and vasodilators (eg, nitrates, nifedipine). Beta-adrenergic blockers should not be used unless concomitant vasodilator therapy is given.
Frishman
William H
WH
Departments of Medicine, The New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA.
Del Vecchio
Alexander
A
Sanal
Shirin
S
Ismail
Anjum
A
D000818:Animals; D003042:Cocaine / Q000737:chemistry / Q000494:pharmacology*; D019970:Cocaine-Related Disorders / Q000150:complications*; D018765:Dopamine Uptake Inhibitors / Q000737:chemistry / Q000494:pharmacology*; D006329:Heart Conduction System / Q000187:drug effects; D006331:Heart Diseases / Q000139:chemically induced* / Q000628:therapy; D006801:Humans; D015394:Molecular Structure; D009131:Muscle, Smooth, Vascular / Q000187:drug effects; D013618:Tachyphylaxis; D014662:Vasoconstrictor Agents / Q000737:chemistry / Q000494:pharmacology*
D018765:Dopamine Uptake Inhibitors; D014662:Vasoconstrictor Agents; D003042:Cocaine