Theodore E. Woodward award: cardiovascular complications of cocaine abuse.
As cocaine abuse has become widespread, it has been associated with various cardiovascular complications, including angina pectoris, myocardial infarction, and sudden cardiac death. Cocaine's principal effects on the cardiovascular system are mediated via alpha-adrenergic stimulation and include (a) an increase in the determinants of myocardial oxygen demand (heart rate and systemic arterial pressure) and (b) a concomitant decrease in myocardial oxygen supply (caused by vasoconstriction of the epicardial coronary arteries). Cocaine-induced coronary arterial vasoconstriction is enhanced at sites of atherosclerotic narrowing. Delayed or recurrent vasoconstriction of the coronary arteries may occur hours after the serum cocaine concentration has declined and appears to be caused by cocaine's major metabolites. Beta-adrenergic blocking agents may exacerbate cocaine-induced coronary arterial vasoconstriction, thereby increasing the magnitude of myocardial ischemia. Concomitant cigarette smoking exacerbates the deleterious effects of cocaine on myocardial oxygen supply and demand substantially.
Lange
Richard A
RA
Department of Internal Medicine, Cardiovascular Division, University of Texas Southwestern Medical Center, Dallas, Texas 75390-8837,, USA.
Cigarroa
Joaquin E
JE
Hillis
L David
LD
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D050197:Atherosclerosis / Q000150:complications / Q000503:physiopathology; D001363:Awards and Prizes; D001792:Blood Platelets / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000503:physiopathology; D003042:Cocaine / Q000494:pharmacology / Q000633:toxicity; D019970:Cocaine-Related Disorders / Q000150:complications* / Q000503:physiopathology; D003331:Coronary Vessels / Q000187:drug effects / Q000503:physiopathology; D006801:Humans; D009203:Myocardial Infarction / Q000209:etiology / Q000503:physiopathology; D017202:Myocardial Ischemia / Q000209:etiology / Q000503:physiopathology; D012907:Smoking / Q000009:adverse effects; D012955:Societies, Medical; D013927:Thrombosis / Q000209:etiology; D014481:United States; D014661:Vasoconstriction / Q000187:drug effects
D000319:Adrenergic beta-Antagonists; D003042:Cocaine