Alcoholic and Cocaine-Associated Cardiomyopathies

Cocaine cardiomyopathy: A case report

“…Patients also may present with acute myocardial decompensation with or without pulmonary edema and shock. In this case, shortness of breath and hypoperfusion dominate the clinical picture (1,6,7,8).…”

“…The use of cocaine is associated with both acute and chronic complications that may involve any system, but the most common system affected is cardiovascular one (2)(3)(4)(5)(6). Cocain related complications include: cardiac (myocardial ischaemia, coronary artery spasm, myocardial infarction (MI), atherosclerosis, myocarditis, cardiomyopathy, arrhythmia, hypertension, and endocarditis); vascular (aortic dissection and rupture, vasculitis); gastrointestinal (mesenteric ischaemia or infarction, perforation); pulmonary (pulmonary oedema, pulmonary infarction, and haemoptysis); genitourinary and obstetric (renal and testicular infarction, abruptio placentae, spontaneous abortion, prematurity, and growth retardation); neurological (seizures, migraine, cerebral infarction, and intracranial hemorrhage); musculoskeletal and dermatological (rhabdomyolysis, skin ischemia, superficial and deep venous thrombosis, and thrombophlebitis (2-6).…”

Drug-Induced Cardiomyopathies

“…The exact incidence of cocaine-induced cardiomyopathy is unknown and likely underreported. The medical literature to date consists mostly of case reports describing young men with a history of cocaine abuse and reversible cardiomyopathy (Awtry and Philippides 2010). In a review of 1278 cases of dilated cardiomyopathy patients, 10 cases were related to cocaine use (Felker et al 1999).…”

“…Finally, as direct putative pathophysiologic mechanisms of cocaine-induced cardiomyopathy and myocarditis, the following has been introduced: hyperadrenergic state produces contraction band necrosis in myocardium, direct toxic effect of cocaine on myofibrils and interstitial fibrosis, and hypersensitivity reaction of myocardium to cocaine. Other mechanisms include myocardial ischemia and infarction as a consequence of increased sympathomimetic activity with increased myocardial oxygen demand, altered calcium flux across myocyte cell membrane, altered vascular endothelium integrity (reduced prostacyclin production), increased platelet thromboxane production and increased plasminogen activator inhibitor production (Maraj et al 2010;Awtry and Philippides 2010). Four mechanisms have been described in more detail (Awtry and Philippides 2010).…”

Chemical Cardiomyopathies: The Negative Effects of Medications and Nonprescribed Drugs on the Heart

“…The mechanisms underlying cocaine cardiomyopathy are not fully understood, but are thought to include sympathomimetic effects, increased calcium flux, enhanced oxidative stress, and promotion of intra-coronary thrombus formation [5].…”