Effects of the intracoronary infusion of cocaine on left ventricular systolic and diastolic function in humans

• Published in: Circulation (New York, N.Y.) N.Y.), 1998-04, Vol.97 (13), p.1270-1273
• Main Authors: PITTS, W. R, VONGPATANASIN, W, CIGARROA, J. E, HILLIS, L. D, LANGE, R. A
• Format: Article
• Language: English
• Subjects: Adult; Aged; Biological and medical sciences; Blood Pressure - drug effects; Cardiac Catheterization; Cocaine - adverse effects; Diastole - drug effects; Drug addictions; Female; Heart Rate - drug effects; Humans; Injections, Intra-Arterial; Male; Medical sciences; Middle Aged; Stroke Volume - drug effects; Systole - drug effects; Toxicology; Vasoconstrictor Agents - adverse effects; Ventricular Dysfunction, Left - chemically induced
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.CIR.97.13.1270

In dogs, a large amount of intravenous cocaine causes a profound deterioration of left ventricular (LV) systolic function and an increase in LV end-diastolic pressure. This study was done to assess the influence of a high intracoronary cocaine concentration on LV systolic and diastolic function in humans. In 20 patients (14 men and 6 women aged 39 to 72 years) referred for cardiac catheterization for the evaluation of chest pain, we measured heart rate, systemic arterial pressure, LV pressure and its first derivative (dP/dt), and LV volumes and ejection fraction before and during the final 2 to 3 minutes of a 15-minute intracoronary infusion of saline (n=10, control subjects) or cocaine hydrochloride 1 mg/min (n=10). No variable changed with saline. With cocaine, the drug concentration in blood obtained from the coronary sinus was 3.0+/-0.4 (mean+/-SD) mg/L, similar in magnitude to the blood cocaine concentration reported in abusers dying of cocaine intoxication. Cocaine induced no significant change in heart rate, LV dP/dt (positive or negative), or LV end-diastolic volume, but it caused an increase in systolic and mean arterial pressures, LV end-diastolic pressure, and LV end-systolic volume, as well as a decrease in LV ejection fraction. In humans, the intracoronary infusion of cocaine sufficient in amount to achieve a high drug concentration in coronary sinus blood causes a deterioration of LV systolic and diastolic performance.