Special Article
Cocaine-induced myocardial ischemia and infarction: Pathophysiology, recognition, and management

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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 α-adrenergic stimulation and include (1) an increase in the determinants of myocardial oxygen demand (heart rate and systemic arterial pressure), and (2) a concomitant decrease in myocardial oxygen supply (caused by vasoconstriction of the epicardial coronary arteries). β-adrenergic blocking agents may exacerbate cocaine-induced coronary arterial vasoconstriction, thereby increasing the magnitude of myocardial ischemia. In contrast, nitroglycerin and verapamil reverse cocaine-induced hypertension and coronary arterial vasoconstriction; therefore, they are the agents of choice in treating patients with cocaine-associated chest pain.

References (88)

  • FloresED et al.

    Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: Enhanced vasoconstriction at sites of significant stenoses

    J Am Coll Cardiol

    (1990)
  • KuhnFE et al.

    Cocaine produces coronary artery vasoconstriction independent of an intact endothelium

    Chest

    (1992)
  • DanielWC et al.

    Effects of the intracoronary infusion of cocaine on coronary arterial dimensions and blood flow in humans

    Am J Cardiol

    (1996)
  • BoehrerJD et al.

    Hemodynamic effects of intranasal cocaine in humans

    J Am Coll Cardiol

    (1992)
  • MorganJP et al.

    Calcium and cardiovascular function: Intracellular calcium levels during contraction and relaxation of mammalian cardiac and vascular smooth muscle as detected with aequorin

    Am J Med

    (1984)
  • GrantBF et al.

    Concurrent and simultaneous use of alcohol with cocaine: Results of national survey

    Drug Alcohol Depend

    (1990)
  • GanzV

    The acute effect of alcohol on the circulation and on the oxygen metabolism of the heart

    Am Heart J

    (1963)
  • HearnWL et al.

    Cocaethylene is more potent than cocaine in mediating lethality

    Pharmacol Biochem Behav

    (1991)
  • DusenberrySJ et al.

    Labetalol treatment of cocaine toxicity

    Ann Emerg Med

    (1987)
  • BoehrerJD et al.

    Influence of labetalol on cocaine-induced coronary vasoconstriction in humans

    Am J Med

    (1993)
  • WinnifordMD et al.

    Cigarette smoking-induced coronary vasoconstriction in atherosclerotic coronary artery disease and prevention by calcium antagonists and nitroglycerin

    Am J Cardiol

    (1987)
  • BroganWC et al.

    Alleviation of cocaine-induced coronary vasoconstriction by nitroglycerin

    J Am Coll Cardiol

    (1991)
  • NegusBH et al.

    Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil

    Am J Cardiol

    (1994)
  • National Institute on Drug Abuse

    National Household Survey on Drug Abuse: Population Estimates, 1991,

  • National Institute on Drug Abuse

    Epidemiologic Trends in Drug Abuse (Community Epidemiology Work Group, June, 1996)

    NIH Publication No. 96-4126

    (1996)
  • HollanderJE

    The management of cocaine-associated myocardial ischemia

    N Engl J Med

    (1995)
  • CatterallW et al.

    Local anesthetics

  • LangeRA et al.

    Cocaine-induced myocardial ischemia and infarction

    Cardio

    (1990)
  • ColemanDL et al.

    Myocardial ischemia and infarction related to recreational cocaine use

    West J Med

    (1982)
  • HowardRE et al.

    Acute myocardial infarction following cocaine abuse in a young woman with normal coronary arteries

    JAMA

    (1985)
  • IsnerJM et al.

    Cocaine-induced myocardial infarction: Clinical observations and pathogenetic considerations

    NIDA Research Monograph

    (1991)
  • HadjimiltiadesS et al.

    Coronary arteriographic findings in cocaine abuse-induced myocardial infarction

    Cathet Cardiovasc Diagn

    (1988)
  • MinorRL et al.

    Cocaine-induced myocardial infarction in patients with normal coronary arteries

    Ann Intern Med

    (1991)
  • IsnerJM et al.

    Acute cardiac events temporally related to cocaine abuse

    N Engl J Med

    (1986)
  • CreglerLL et al.

    Medical complications of cocaine abuse

    N Engl J Med

    (1986)
  • MittlemanRE et al.

    Death caused by recreational cocaine use: An update

    JAMA

    (1984)
  • WilkinsCE et al.

    Myocardial infarction associated with cocaine abuse

    Texas Heart J

    (1986)
  • SchachneJS et al.

    Coronaryartery spasm and myocardial infarction associated with cocaine use

    N Engl J Med

    (1984)
  • GouldL et al.

    Cocaine-induced myocardial infarction

    N Y State J Med

    (1985)
  • SmithHW et al.

    Acute myocardial infarction temporally related to cocaine use: Clinical, angiographic, and pathophysiologic observations

    Ann Intern Med

    (1987)
  • StenbergRG et al.

    Simultaneous acute thrombosis of two major coronary arteries following intravenous cocaine use

    Arch Pathol Lab Med

    (1989)
  • LangeRA et al.

    Cocaine-induced coronary artery vasoconstriction

    N Engl J Med

    (1989)
  • GanzW et al.

    Measurement of coronary sinus blood flow by continuous thermodilution in man

    Circulation

    (1971)
  • ReiberJHC et al.

    Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms

    Circulation

    (1985)
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