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If you don't remember your password, you can reset it by entering your email address and clicking the Reset Password button. You will then receive an email that contains a secure link for resetting your password. Your email address is a required field. Your password is a required field. Forgot password? Remember me. Property Value Status. Main menu Articles. Popular Articles Society Guidelines. Society Guidelines. Latest Articles Clinical Research. Images in Cardiology. Case Report. For Authors Submit Article. Collections CCS Guidelines. Society CCS. Contact Contact Us Career Opportunities. Go search Advanced search. Please enter a term before submitting your search. Download Full Issue Download started Ok. Get Access. Previous article Next article. Abstract Abstract Cocaine is one of the most commonly abused drugs and represents a major public health concern. Cocaine users frequently present to the emergency department, with chest pain being the most common presenting complaint. Risk assessment can be challenging in these patients; serial assessment of electrocardiograms and troponins is often required. This review focuses on the assessment and management of patients presenting with cocaine-associated chest pain and cardiotoxicity. Specific treatments are discussed, including benzodiazepines, nitroglycerin, calcium channel blockers, and phentolamine, and how treatment priorities differ from patients with noncocaine presentations. The use of beta-blockers in this population remains controversial, and the literature around its use is reviewed. The most recent literature and recommendations for the use of percutaneous coronary intervention and fibrinolytics in cocaine-associated myocardial infarction is discussed as well. Cocaine-associated dysrhythmias are suggested to be the cause of sudden cardiac death in some users. The pathophysiology and evidence-based treatments for dysrhythmias are reviewed. This review provides evidence-based recommendations for the assessment and management of patients presenting with cocaine-associated cardiovascular toxicity. Get full text access Log in, subscribe or purchase for full access. References 1. Google Scholar. Cocaine: what is the crack? A brief history of the use of cocaine as an anaesthetic. Scopus 0. Scopus Hospital stays for harm caused by substance use, breakdown by substance and age. Cardiovascular and subjective effects of intravenous cocaine administration in humans. Acute tolerance development to the cardiovascular and subjective effects of cocaine. Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade. Full Text PDF. Effect of cocaine on coronary artery dimensions in atherosclerotic coronary artery disease: enhanced vasoconstriction at sites of significant stenoses. Increase in atherosclerosis and adventitial mast cells in cocaine abusers: an alternative mechanism of cocaine-associated coronary vasospasm and thrombosis. Quantitative analysis of amounts of coronary arterial narrowing in cocaine addicts. Evidence of cocaine-related coronary atherosclerosis in young patients with myocardial infarction. Influence of intranasal cocaine on plasma constituents associated with endogenous thrombosis and thrombolysis. Cocaine activates platelets and increases the formation of circulating platelet containing microaggregates in humans. Cocaine increases the endothelial release of immunoreactive endothelin and its concentrations in human plasma and urine: reversal by coincubation with sigma-receptor antagonists. Cardiomyocyte apoptosis in cocaine-induced myocarditis with involvement of bundle of His and left bundle branch. Full Text. Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals. Cocaine induces apoptosis in primary cultured rat aortic vascular smooth muscle cells: possible relationship to aortic dissection, atherosclerosis, and hypertension. Characterisation of the sodium channel blocking properties of the major metabolites of cocaine in single cardiac myocytes. Cocaine-induced channelopathies: emerging evidence on the multiple mechanisms of sudden death. Ischemia enhances use-dependent sodium channel blockade by pilsicainide, a class IC antiarrhythmic agent. Cocaine-related sudden cardiac death: a hypothesis correlating basic science and clinical observations. The effect of cocaine on ventricular fibrillation threshold in the normal canine heart. Cocaine-induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil. Acute coronary syndrome and cocaine use: 8-year prevalence and inhospital outcomes. Management of cocaine-induced cardiac arrhythmias due to cardiac ion channel dysfunction. Mortality and morbidity in patients receiving encainide, flecainide, or placebo. The Cardiac Arrhythmia Suppression Trial. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. Effects of pH on the myofilaments and the sarcoplasmic reticulum of skinned cells from cardiac and skeletal muscles. Influence of lactic acidosis on cardiovascular response to sympathomimetic amines. Prospective multicentre evaluation of cocaine-associated chest pain. Cocaine-induced myocardial infarction: an analysis and review of the literature. Recurrent coronary vasoconstriction caused by intranasal cocaine: possible role for metabolites. Cardiac and hemodynamic assessment of patients with cocaine-associated chest pain syndromes. Randomised, double-blind, placebo-controlled trial of diazepam, nitroglycerin, or both for treatment of patients with potential cocaine-associated acute coronary syndromes. Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both. Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey. Cocaine-associated myocardial infarction. Mortality and complications. Prevalence of myocardial infarction among patients with chest pain and cocaine use: a systematic review and meta-analysis. Myocardial perfusion imaging with technetiumm sestamibi in patients with cocaine-associated chest pain. A prospective, randomised, controlled trial of benzodiazepines and nitroglycerine or nitroglycerine alone in the treatment of cocaine-associated acute coronary syndromes. Acute cardiac ischemia in patients with cocaine-associated complaints: results of a multicentre trial. Cocaine and chest pain: clinical features and outcome of patients hospitalised to rule out myocardial infarction. Acute myocardial infarction temporally related to cocaine use. Clinical, angiographic, and pathophysiologic observations. Recurrent myocardial infarction associated with cocaine abuse in a young man with normal coronary arteries: evidence for coronary artery spasm culminating in thrombosis. Cocaine-induced myocardial infarction in patients with normal coronary arteries. Coronary arteriographic findings in cocaine abuse-induced myocardial infarction. Coronary artery spasm, cardiac arrest, transient electrocardiographic Q waves and stunned myocardium in cocaine-associated acute myocardial infarction. Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. High prevalence of recent cocaine use and the unreliability of patient self-report in an inner-city walk-in clinic. Clinical interpretation of urine drug tests: what clinicians need to know about urine drug screens. Protracted elimination of cocaine metabolites in long-term high-dose cocaine abusers. The prognostic value of HEART score in patients with cocaine-associated chest pain: an age- and sex-matched cohort study. Cardiac troponin I and T concentrations in patients with cocaine-associated chest pain. Effect of recent cocaine use on the specificity of cardiac markers for diagnosis of acute myocardial infarction. Troponin elevations only detected with a high-sensitivity assay: clinical correlations and prognostic significance. Self-reported cocaine use is not associated with elevations in high-sensitivity troponin I. 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. A pilot study to assess the safety of dobutamine stress echocardiography in the emergency department evaluation of cocaine-associated chest pain. Cocaine-using patients with a normal or nondiagnostic electrocardiogram: single-photon emission computed tomography myocardial perfusion imaging and outcome. Assessment of myocardial infarction by CT angiography and cardiovascular MRI in patients with cocaine-associated chest pain: a pilot study. Scopus 8. Coronary computerized tomography angiography for rapid discharge of low-risk patients with cocaine-associated chest pain. Relationship between cocaine use and coronary artery disease in patients with symptoms consistent with an acute coronary syndrome. Validation of a brief observation period for patients with cocaine-associated chest pain. One-year medical outcomes and emergency department recidivism after emergency department observation for cocaine-associated chest pain. Chemical restraint for the agitated patient in the emergency department: lorazepam versus droperidol. Midazolam selectively potentiates the A 2A - but not A 1 -receptor—mediated effects of adenosine: role of nucleoside transport inhibition and clinical implications. Acute cocaine intoxication in the conscious dog: studies on the mechanism of lethality. Peripheral administration of nitroglycerin in pulseless ventricular tachycardia due to cocaine-induced coronary vasospasm. Alleviation of cocaine-induced coronary vasoconstriction with intravenous verapamil. The Tox and the Hound, April 9, Beta-blockers are associated with reduced risk of myocardial infarction after cocaine use. Death temporally related to the use of a beta adrenergic receptor antagonist in cocaine-associated myocardial infarction. Experience with esmolol for the treatment of cocaine-associated cardiovascular complications. Cocaine use is associated with an increased risk of stent thrombosis after percutaneous coronary intervention. Increased incidence of in-stent thrombosis related to cocaine use: case series and review of literature. Invasive approaches in the management of cocaine-associated non—ST-segment elevation myocardial infarction. A word of caution about thrombolytic therapy. Experimental amitriptyline intoxication: treatment of cardiac toxicity with sodium bicarbonate. A literature review of the use of sodium bicarbonate for the treatment of QRS widening. Hemodynamic and electrophysiological actions of cocaine. Effects of sodium bicarbonate as an antidote in dogs. Case files of the medical toxicology fellowship at the Toxikon consortium in Chicago: cocaine-associated wide-complex dysrhythmias and cardiac arrest—treatment nuances and controversies. Comparative effects of sodium bicarbonate and sodium chloride on reversing cocaine-induced changes in the electrocardiogram. Antiarrhythmic agents: the modulated receptor mechanism of action of sodium and calcium channel-blocking drugs. Cocaine concentration-effect relationship in the presence and absence of lidocaine: evidence of competitive binding between cocaine and lidocaine. Reversal of the electrocardiographic effects of cocaine by lidocaine. Part 2. Concentration-effect relationships. Part 1. Comparison with sodium bicarbonate and quinidine. Clinical safety of lidocaine in patients with cocaine-associated myocardial infarction. Management of cocaine-associated non-ST-segment elevation myocardial infarction: is an invasive approach beneficial? Article metrics. Scott N. Search for articles by this author. View full text. Hide Caption Download See figure in Article. Toggle Thumbstrip. Go to. Show all references. Expand Table. The content on this site is intended for healthcare professionals. We use cookies to help provide and enhance our service and tailor content. 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European data from the European Monitoring Centre for Drugs and Drug Addiction report on cocaine Paraschin K, Guerra De Andrade A, Rodrigues.
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Objectives: Cocaine is a commonly used illicit drug that leads to the most emergency department ED visits. Our aim was to evaluate the incidence of previous myocardial infarction among young cocaine users 18—40 years with cocaine-associated chest pain by the assessment of myocardial fibrosis by cardiovascular MRI. Methods: 24 cocaine users 22 males who frequently complained about cocaine-associated chest pain underwent CTA and cardiovascular MRI. Mean age of patients was Among the coronary segments evaluated, only one patient had calcified plaques at the anterior descending coronary artery proximal and medium segments. Assessment of regional ventricular function by the evaluation of 17 segments was normal in all patients. None of the patients showed myocardial delayed enhancement, indicative of myocardial fibrosis. Conclusion: Cardiovascular MR did not detect the presence of delayed enhancement indicative of myocardial fibrosis among young cocaine users with low cardiovascular risk who had complained of cocaine-associated chest pain. Access to content on Oxford Academic is often provided through institutional subscriptions and purchases. If you are a member of an institution with an active account, you may be able to access content in one of the following ways:. Typically, access is provided across an institutional network to a range of IP addresses. This authentication occurs automatically, and it is not possible to sign out of an IP authenticated account. Choose this option to get remote access when outside your institution. Enter your library card number to sign in. If you cannot sign in, please contact your librarian. Many societies offer single sign-on between the society website and Oxford Academic. 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Cocaine is one of the most commonly abused drugs and represents a major public health concern. Cocaine users frequently present to the.
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