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

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...

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Bibliographic Details
Published in:Progress in cardiovascular diseases 1997-07, Vol.40 (1), p.65-76
Main Authors: Pitts, William R., Lange, Richard A., Cigarroa, Joaquin E., David Hillis, L.
Format: Article
Language:English
Subjects:
Adrenergic beta-Antagonists - adverse effects
Alcohol Drinking - adverse effects
Animals
Biological and medical sciences
Calcium Channel Blockers - therapeutic use
Cocaine - adverse effects
Coronary Vessels - drug effects
Drug addictions
Drug Synergism
Humans
Medical sciences
Myocardial Infarction - chemically induced
Myocardial Infarction - drug therapy
Myocardial Infarction - physiopathology
Myocardial Ischemia - chemically induced
Myocardial Ischemia - drug therapy
Myocardial Ischemia - physiopathology
Smoking - adverse effects
Substance-Related Disorders
Toxicology
Vasoconstriction - drug effects
Vasoconstrictor Agents - adverse effects
Vasodilator Agents - therapeutic use
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Summary: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.
ISSN:0033-0620
1532-8643
DOI:10.1016/S0033-0620(97)80023-0