In contrast to other addictive drugs that have fewer pathophysiological pathways by which to impact the cardiovascular system, cocaine with its multitude of pathways represents a considerable threat to users, according to a review article published June 26 in the Journal of the American College of Cardiology.

The article highlights the varied cardiovascular effects of the highly addictive drug, including hypertension, aortic dissection, myocardial ischemia and infarction, cardiomyopathy and heart failure, arrhythmias, pulmonary hypertension and stroke. “Considering the deleterious effect cocaine can have on the oxygen supply/demand balance, it is not surprising that chest pain is the chief complaint in cocaine abusers presenting to emergency departments, and that the risk of myocardial infarction (MI) was found to increase up to 24-fold in the first hour after cocaine abuse,” the authors note. They also point out that “both the increased prevalence of cigarette smoking and the inhaled crack might predispose cocaine users to chronic lung injury, with subsequent increased risk for pulmonary hypertension.”

The review’s authors point out several treatment approaches to treating cocaine-related admissions given that the drug may provoke a variety of cardiovascular complications. “A systematic approach toward the patient’s clinical status including simple yet important initial tests can help with identifying and appropriately addressing these potential complications,” they write. They recommend clinicians check history and vitals and perform a physical examination, as well as an electrocardiogram. The authors also suggest monitoring of heart rhythm, body temperature and pulmonary hypertension, along with consideration of specific tests, such as echocardiography or computed tomography, based on findings. For patients with continued ST-segment elevation on ECGs, they recommend direct referral for coronary angiography with possible angioplasty and stent implantation. In accordance with ACC/AHA guidelines for the management of unstable angina/NSTEMI, they note that bare-metal stents should be considered for use in cocaine patients. 

Looking ahead, the authors allude to further research needed on the behavioral influence of cocaine on patient outcomes. They also point out concerning new data showing an increasing prevalence of cocaine abuse in teens and children, which might pose even greater issues with treatment. 

Keywords: Adolescent, Angina, Unstable, Angioplasty, Arrhythmias, Cardiac, Body Temperature, Cardiomyopathies, Cardiovascular System, Chest Pain, Cocaine, Cocaine-Related Disorders, Coronary Angiography, Coronary Artery Disease, Echocardiography, Emergency Service, Hospital, Heart Failure, Hypertension, Hypertension, Pulmonary, Infarction, Lung Injury, Myocardial Infarction, Myocardial Infarction, Oxygen, Referral and Consultation, Smoking, Stents, Stroke, Tomography

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