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Frequency of coronary artery disease and left ventricular dysfunction in cocaine users

To evaluate the spectrum of coronary artery disease (CAD) in cocaine users, coronary angiograms obtained from 33 patients (26 men [79%] and 7 women [21%], mean age 37 years) with history of cocaine use and cardiac symptoms were retrospectively reviewed. Clinical indications for coronary angiograms included chest pain (n = 28), congestive failure (n = 4) and complete heart block (n = 1). Coronary angiograms were reviewed independently by 2 angiographers unaware of patients clinical status. Thirteen patients (40%) had normal coronary angiograms, and 20 (60%) had CAD; 7 (21%) had mild CAD (less than or equal to 70% diameter stenosis), and 13 (40%) had significant CAD (greater than 70% diameter stenosis). Of 13 patients with significant CAD, 7 had 1-vessel, 4 had 2-vessel and 2 had 3-vessel CAD. There was enzymatic evidence of myocardial infarction in 12 of 33 patients (36%); all 12 had CAD (10 with significant and 2 with mild CAD). Mean age and number of risk factors (serum total cholesterol, cigarette smoking, systemic hypertension, diabetes mellitus, family history of CAD, and obesity) in patients with CAD (mild or significant) and with normal coronary angiograms were not statistically different. Left ventricular ejection fraction was normal in 15 patients (45%) and depressed in 18 (55%). All patients with CAD and low ejection fractions (n = 12) had regional wall motion abnormalities, whereas all those with normal coronary arteries and low ejection fraction (n = 6) had global hypokinesia.

Medical complications of cocaine: possible relationship to low plasma cholinesterase enzyme.

What predisposes some cocaine users to its complications is not known. Because cocaine is metabolized by plasma cholinesterase enzyme, we evaluated this enzyme in 14 patients with cocaine-induced complications, 11 long-term cocaine users from Bolivia, 14 persons in the United States without any documented cocaine-induced complications, and 14 subjects who have not used cocaine. The enzyme was found to be significantly lower in patients with cocaine-induced complications as compared to other groups (p < 0.05). A low level of plasma cholinesterase enzyme may predict complications from cocaine use.

Radiation-induced coronary artery disease

Excessive unprotected radiation to the heart appears to lead to the development of CAD, even in the absence of significant cardiovascular risk factors. The coexistence of such factors may enhance the probability of CAD. The presence of hypercholesterolemia and concomitant or sequential use of chemotherapeutic agents (especially doxorubicin) could further increase this risk. Therapeutic decisions, as with any other manifestation of CAD, relate to the extent of myocardium at jeopardy and to the overall diffuseness of CAD. Management options possible are PTCA or coronary artery bypass surgery. The latter may be required in left main artery stenosis and complicated ostial lesions. Use of shielding should decrease the associated risk of radiation-induced CAD in future years. However, clinicians should continue to have a high degree of suspicion of CAD in patients treated with thoracic radiation without cardiac shielding.

Cardiovascular Complications of Cocaine

Cocaine use is escalating in the United States. Cocaine produces sympathomimetic effects and causes generalized vasoconstriction involving multiple organ systems. Its cardiovascular complications may be life-threatening and include myocardial infarction, myocarditis, cardiomyopathy, arrhythmias, and aortic dissection. Accurate diagnosis and prompt management can be life-saving. This review focuses on the current information available on the cardiovascular complications of cocaine and suggests guidelines regarding their management strategies.