The increasingly widespread use of cocaine in the United States has been accompanied and perhaps exacerbated by the misconception that the drug is not associated with serious medical complications. In particular, the potential for cocaine to precipitate life-threatening cardiac events needs to be reemphasized. We report the clinical and pathological findings in seven people in whom nonintravenous "recreational" use of cocaine was temporally related to acute myocardial infarction, ventricular tachycardia and fibrillation, myocarditis, sudden death, or a combination of these events. We also review data on 19 previously reported cases of cocaine-related cardiovascular disorders. Analysis of all 26 patients indicated the following findings: the cardiac consequences of cocaine abuse are not unique to parenteral use of the drug, since nearly all the patients took the drug intranasally; underlying heart disease is not a prerequisite for cocaine-related cardiac disorders; seizure activity, a well-documented noncardiac complication of cocaine abuse, is neither a prerequisite for, nor an accompanying feature of, cardiac toxicity of cocaine; and the cardiac consequences of cocaine are not limited to massive doses of the drug. Although the pathogenesis of cardiac toxicity of cocaine remains incompletely defined, available circumstantial evidence suggests that cocaine has medical consequences that are equal in importance to its well-documented psychosocial consequences.
This article has been cited by other articles:
McCord, J., Jneid, H., Hollander, J. E., de Lemos, J. A., Cercek, B., Hsue, P., Gibler, W. B., Ohman, E. M., Drew, B., Philippides, G., Newby, L. K.
(2008). Management of Cocaine-Associated Chest Pain and Myocardial Infarction: A Scientific Statement From the American Heart Association Acute Cardiac Care Committee of the Council on Clinical Cardiology. Circulation
117: 1897-1907
[Full Text]
Rezkalla, S. H., Kloner, R. A.
(2007). Cocaine-Induced Acute Myocardial Infarction. Clin Med Res
5: 172-176
[Abstract][Full Text]
Egred, M, Davis, G K
(2005). Cocaine and the heart. Postgrad. Med. J.
81: 568-571
[Abstract][Full Text]
Henning, R. J., Li, Y.
(2003). Cocaine Produces Cardiac Hypertrophy by Protein Kinase C Dependent Mechanisms. J CARDIOVASC PHARMACOL THER
8: 149-160
[Abstract]
Samenuk, D., Link, M. S., Homoud, M. K., Contreras, R., Theohardes, T. C., Wang, P. J., Estes, N. A. M. III
(2002). Adverse Cardiovascular Events Temporally Associated With Ma Huang, an Herbal Source of Ephedrine. Mayo Clin Proc.
77: 12-16
[Abstract]
Ferreira, S., Crumb, W. J. Jr., Carlton, C. G., Clarkson, C. W.
(2001). Effects of Cocaine and Its Major Metabolites on the HERG-Encoded Potassium Channel. J. Pharmacol. Exp. Ther.
299: 220-226
[Abstract][Full Text]
Da Costa, A, Isaaz, K, Faure, E, Mourot, S, Cerisier, A, Lamaud, M
(2001). Clinical characteristics, aetiological factors and long-term prognosis of myocardial infarction with an absolutely normal coronary angiogram; a 3-year follow-up study of 91 patients. Eur Heart J
22: 1459-1465
[Abstract]
Lange, R. A., Hillis, L. D.
(2001). Cardiovascular Complications of Cocaine Use. NEJM
345: 351-358
[Full Text]
Nallamothu, B. K., Saint, S., Kolias, T. J., Eagle, K. A.
(2001). Of Nicks and Time. NEJM
345: 359-363
[Full Text]
Vidhani, K., Parr, M.
(2001). The role of recreational drugs in trauma. Trauma
3: 25-31
[Abstract]
Marder, V. J., Mellinghoff, I. K.
(2000). Cocaine and Buerger Disease: Is There a Pathogenetic Association?. Arch Intern Med
160: 2057-2060
[Abstract][Full Text]
Ghuran, A, Nolan, J
(2000). Recreational drug misuse: issues for the cardiologist. Heart
83: 627-633
[Full Text]
Shannon, R. P., Mathier, M. A., Shen, Y.-T.
(2000). Coronary vascular responses to short-term cocaine administration in conscious baboons compared with dogs. J Am Coll Cardiol
35: 1347-1354
[Abstract][Full Text]
Vongpatanasin, W., Mansour, Y., Chavoshan, B., Arbique, D., Victor, R. G.
(1999). Cocaine Stimulates the Human Cardiovascular System via a Central Mechanism of Action. Circulation
100: 497-502
[Abstract][Full Text]
Shi, B., Heavner, J. E., Liu, J., Wang, M. J., Lutherer, L. O., McIntyre, D. C., Reigel, C. E.
(1999). Two Genetically Selected Strains of Rats Exhibit Hypersensitivity or Resistance to Cocaine-Induced Fatal Arrhythmias. J. Pharmacol. Exp. Ther.
288: 685-692
[Abstract][Full Text]
Knuepfer, M. M., Gan, Q.
(1999). Role of cholinergic receptors and cholinesterase activity in hemodynamic responses to cocaine in conscious rats. Am. J. Physiol. Regul. Integr. Comp. Physiol.
276: R103-R112
[Abstract][Full Text]
Wilbert-Lampen, U., Seliger, C., Zilker, T., Arendt, R. M.
(1998). Cocaine Increases the Endothelial Release of Immunoreactive Endothelin and Its Concentrations in Human Plasma and Urine : Reversal by Coincubation With {sigma}-Receptor Antagonists. Circulation
98: 385-390
[Abstract][Full Text]
Marzuk, P. M., Tardiff, K., Leon, A. C., Hirsch, C. S., Portera, L., Iqbal, M. I., Nock, M. K., Hartwell, N.
(1998). Ambient Temperature and Mortality From Unintentional Cocaine Overdose. JAMA
279: 1795-1800
[Abstract][Full Text]
Xiao, Y.-F., Morgan, J. P.
(1998). Cocaine Blockade of the Acetylcholine-Activated Muscarinic K+ Channel in Ferret Cardiac Myocytes. J. Pharmacol. Exp. Ther.
284: 10-18
[Abstract][Full Text]
Knuepfer, M. M., Gan, Q.
(1997). Effects of Proposed Treatments for Cocaine Addiction on Hemodynamic Responsiveness to Cocaine in Conscious Rats. J. Pharmacol. Exp. Ther.
283: 592-603
[Abstract][Full Text]
Maron, B. J., Thompson, P. D., Puffer, J. C., McGrew, C. A., Strong, W. B., Douglas, P. S., Clark, L. T., Mitten, M. J., Crawford, M. H., Atkins, D. L., Driscoll, D. J., Epstein, A. E.
(1996). Cardiovascular Preparticipation Screening of Competitive Athletes: A Statement for Health Professionals From the Sudden Death Committee (Clinical Cardiology) and Congenital Cardiac Defects Committee (Cardiovascular Disease in the Young), American Heart Association. Circulation
94: 850-856
[Full Text]
Maron, B. J., Shirani, J., Poliac, L. C., Mathenge, R., Roberts, W. C., Mueller, F. O.
(1996). Sudden Death in Young Competitive Athletes: Clinical, Demographic, and Pathological Profiles. JAMA
276: 199-204
[Abstract]
Liberthson, R. R.
(1996). Sudden Death from Cardiac Causes in Children and Young Adults. NEJM
334: 1039-1044
[Full Text]
Mendelson, J. H., Mello, N. K.
(1996). Management of Cocaine Abuse and Dependence. NEJM
334: 965-972
[Full Text]
Mehta, P. M., Grainger, T. A., Lust, R. M., Movahed, A., Terry, J., Gilliland, M.G.F., Jolly, S. R.
(1995). Effect of Cocaine on Left Ventricular Function : Relation to Increased Wall Stress and Persistence After Treatment. Circulation
91: 3002-3009
[Abstract][Full Text]
Pirwitz, M. J., Willard, J. E., Landau, C., Lange, R. A., Glamann, D. B., Kessler, D. J., Foerster, E. H., Todd, E., Hillis, L. D.
(1995). Influence of Cocaine, Ethanol, or Their Combination on Epicardial Coronary Arterial Dimensions in Humans. Arch Intern Med
155: 1186-1191
[Abstract]
Jaffe, B. D., Broderick, T. M., Leier, C. V.
(1994). Cocaine-Induced Coronary-Artery Dissection. NEJM
330: 510-511
[Full Text]
Kolodgie, F. D., Wilson, P. S., Cornhill, J. F., Herderick, E. E., Mergner, W. J., Virmani, R.
(1993). Increased Prevalence of Aortic Fatty Streaks in Cholesterol-Fed Rabbits Administered Intravenous Cocaine: The Role of Vascular Endothelium*1. Toxicol Pathol
21: 425-435
[Abstract]
Michels, R., Marzuk, P. M.
(1993). Progress in Psychiatry- Second of Two Parts. NEJM
329: 628-638
[Full Text]
Brogan, W. C. III, Lange, R. A., Glamann, D. B., Hillis, L. D.
(1992). Recurrent Coronary Vasoconstriction Caused by Intranasal Cocaine: Possible Role for Metabolites. ANN INTERN MED
116: 556-561
[Abstract]
Rees, T. D.
(1992). Oral Effects of Drug Abuse. CROBM
3: 163-184
[Abstract][Full Text]
Minor, R. L. Jr., Scott, B. D., Brown, D. D., Winniford, M. D.
(1991). Cocaine-induced Myocardial Infarction in Patients with Normal Coronary Arteries. ANN INTERN MED
115: 797-806
[Abstract]
Gitter, M. J., Goldsmith, S. R., Dunbar, D. N., Sharkey, S. W.
(1991). Cocaine and Chest Pain: Clinical Features and Outcome of Patients Hospitalized to Rule Out Myocardial Infarction. ANN INTERN MED
115: 277-282
[Abstract]
Valentine, J. L., Yamanashi, W. S., Leak, D., Saksanen, S., Wagner, B. D., Phillips, S. W.
(1991). Effects of Cocaine on Canines' Coronary Arteries. ANGIOLOGY
42: 568-575
[Abstract]
Hanzlick, R., Gowitt, G. T.
(1991). Cocaine Metabolite Detection in Homicide Victims. JAMA
265: 760-761
[Abstract]
Brooks, R., McGovern, B. A., Garan, H., Ruskin, J. N.
(1991). Current Treatment of Patients Surviving Out-of-Hospital Cardiac Arrest. JAMA
265: 762-768
[Abstract]
Lange, R. A., Cigarroa, R. G., Flores, E. D., McBride, W., Kim, A. S., Wells, P. J., Bedotto, J. B., Danziger, R. S., Hillis, L. D.
(1990). Potentiation of Cocaine-Induced Coronary Vasoconstriction by Beta-Adrenergic Blockade. ANN INTERN MED
112: 897-903
[Abstract]
Chokshi, S. K., Moore, R., Pandian, N. G., Isner, J. M.
(1989). Reversible Cardiomyopathy Associated with Cocaine Intoxication. ANN INTERN MED
111: 1039-1040
[Abstract]
Nademanee, K., Gorelick, D. A., Josephson, M. A., Ryan, M. A., Wilkins, J. N., Robertson, H. A., Mody, F. V., Intarachot, V.
(1989). Myocardial Ischemia during Cocaine Withdrawal. ANN INTERN MED
111: 876-880
[Abstract]
Klonoff, D. C., Andrews, B. T., Obana, W. G.
(1989). Stroke Associated With Cocaine Use. Arch Neurol
46: 989-993
[Abstract]
Chasnoff, I. J., Griffith, D. R., MacGregor, S., Dirkes, K., Burns, K. A.
(1989). Temporal Patterns of Cocaine Use in Pregnancy: Perinatal Outcome. JAMA
261: 1741-1744
[Abstract]
Robin, E. D., Wong, R. J., Ptashne, K. A.
(1989). Increased Lung Water and Ascites after Massive Cocaine Overdosage in Mice and Improved Survival Related to Beta-Adrenergic Blockage. ANN INTERN MED
110: 202-207
[Abstract]
Telsey, A. M., Merrit, T. A., Dixon, S. D.
(1988). Cocaine Exposure in a Term Neonate: Necrotizing Enterocolitis as a Complication. CLIN PEDIATR
27: 547-550
[Abstract]
ZAMORA-QUEZADA, J. C., DINERMAN, H., STADECKER, M. J., KELLY, J. J.
(1988). Muscle and Skin Infarction after Free-Basing Cocaine (Crack). ANN INTERN MED
108: 564-566
[Abstract]
EDWARDS, J., RUBIN, R. N.
(1987). Aortic Dissection and Cocaine Abuse. ANN INTERN MED
107: 779-780
[Abstract]
SMITH, H. W. B. III, LIBERMAN, H. A., BRODY, S. L., BATTEY, L. L., DONOHUE, B. C., MORRIS, D. C.
(1987). Acute Myocardial Infarction Temporally Related to Cocaine Use: Clinical, Angiographic, and Pathophysiologic Observations. ANN INTERN MED
107: 13-18
[Abstract]
Tuncel, M., Wang, Z., Arbique, D., Fadel, P. J., Victor, R. G., Vongpatanasin, W.
(2002). Mechanism of the Blood Pressure--Raising Effect of Cocaine in Humans. Circulation
105: 1054-1059
[Abstract][Full Text]
Previous
