title: Dilated cardiomyopathy secondary to chronic cocaine abuse: a case report.
abstract: BACKGROUND
  Cocaine is a potent sympathomimetic agent associated with the development of possible fatal cardiovascular complications. Dysrhythmias, acute myocardial infarction, hypertension and dilated cardiomyopathy are just some of many cardiovascular effects related to the abuse of cocaine.
  
  
  METHODS
  A 38-year-old Hispanic male with a past medical history of hypertension presented with a chief complaint of progressive shortness of breath. The patient confessed to the use of cocaine for almost 18 years once per week. On examination he was hypertensive and tachycardic with a systolic murmur over the 5th intercostal space at the level of the left mid-clavicular line. Laboratory workup revealed an elevated Brain natriuretic peptide; urine toxicology was positive for cocaine. 2D-echocardiogram showed dilated cardiomyopathy. Cardiac catheterization excluded angioischemic cause. He was managed medically and subsequently discharged with drug rehabilitation. On follow-up diagnostic evaluation after 5 months of cocaine cessation, his ejection function improved significantly.
  
  
  CONCLUSIONS
  The exact incidence of cocaine related cardiomyopathy is unknown and likely underreported. The clinical course is abrupt and comparatively similar to other types of cardiomyopathy. The management is like other forms of cardiomyopathy; however β-blockers should be avoided. The myocardial dysfunction is reversible with abstaining from additional cocaine ingestion. Non-invasive testing should be performed after several months to re-evaluate the treatment response.
authors.forename: Chad J
authors.initials: CJ
authors.lastname: Cooper
authors.forename: Sarmad
authors.initials: S
authors.lastname: Said
authors.forename: Haider
authors.initials: H
authors.lastname: Alkhateeb
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Remi
authors.initials: R
authors.lastname: Trien
authors.forename: Shajeea
authors.initials: S
authors.lastname: Ajmal
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Blandon
authors.affiliation: Department of Internal Medicine, Paul L, Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA. german.hernandez@ttuhsc.edu.
authors.forename: German T
authors.initials: GT
authors.lastname: Hernandez
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology* / Q000652:urine; D003042:Cocaine / Q000008:administration & dosage* / Q000652:urine; D019970:Cocaine-Related Disorders / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology* / Q000652:urine; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood; D013318:Stroke Volume
chemical_list: D020097:Natriuretic Peptide, Brain; D003042:Cocaine