Cardiovascular complications of cocaine: Imaging findings

Restrepo, Carlos S.; Rojas, Carlos; Martínez, Santiago; Riascos, Roy; Marmol-Velez, Alejandro; Carrillo, Jorge; Vargas, Daniel

doi:10.1007/s10140-008-0762-x

Cited by 33 publications

(26 citation statements)

References 69 publications

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“…Cerebral infarcts are seen to involve the middle cerebral artery territories ( Figure 3) up to 83% of the time. 1 Note, however, that in mild to moderate cocaine users, no abnormal findings may be present on noncontrast head CT examinations, possibly as a result of subclinical disease. Focal perfusion deficits often affect the frontal and temporal lobes.…”

Section: Central Nervous System Effectsmentioning

confidence: 97%

“…Cocaine-induced acute myocardial infarction should be suspected in young patients presenting with chest pain and electrocardiographic abnormalities because up to 25% of 18-to 45-year-old patients with acute myocardial infarction were cocaine users. 1 Cardiomyopathy resulting from cocaine use can be secondary to ischemia induced by cocaine ( Figure 6). 6 Cocaine acts primarily on the peripheral ␣ 1 adrenergic receptors, causing vasoconstriction and resultant hypertension, but also exacerbates acute myocardial infarction by inducing atherosclerotic change and activating platelets via plasminogen-activator inhibitor and thromboxane A2, which lead to aggregation, increased adhesiveness, and coronary thrombus formation.…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

“…6 Cocaine acts primarily on the peripheral ␣ 1 adrenergic receptors, causing vasoconstriction and resultant hypertension, but also exacerbates acute myocardial infarction by inducing atherosclerotic change and activating platelets via plasminogen-activator inhibitor and thromboxane A2, which lead to aggregation, increased adhesiveness, and coronary thrombus formation. 1 Diagnosis of cardiovascular disorders in the setting of cocaine use hinges on laboratory detection of cocaine metabolites and elevated troponins, and two-dimensional echocardiograms showing wall motion abnormalities. 1 Cardiomyopathy resulting from cocaine use can be secondary to ischemia induced by cocaine ( Figure 6).…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

“…These effects are then compounded by cocaine's sympathomimetic effects, prostacyclin decrease, and possible procoagulant effects by depletion of antithrombin III and protein C. Cocaine use accelerates atherosclerosis by increasing permeability of the endothelial cell barrier to low-density lipoproteins and enhancing leukocyte migration. 1 Resting perfusion imaging with technetium-99m Sestamibi may be of use if obtained immediately, but this modality is seldom available in the acute setting. Generally, cocaine-induced cardiomyopathy is thought to be global and progressive but may improve with cessation of cocaine use.…”

Section: Cardiovascular Effectsmentioning

confidence: 99%

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Imaging of Emergency Department Patients With Cocaine Intoxication

2012

Contemporary Diagnostic Radiology

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Cocaine is the second most abused illicit drug in the United States with 2.4 million users in 2006 (Cannabis is the leading offender). Cocaine is also the most common recreational drug resulting in emergency department visits. According to the Drug Abuse Warning Network, a public health surveillance system, there were 2.1 million drug-abuse-related emergency department visits in the United States in 2008, and more than 400,000 of these visits directly involved cocaine use. Based on the 2010 National Survey on Drug Use and Health report, the 18-to 25-year-old population accounted for nearly 45% of illicit drug use during 2010, with those aged 26 to 34 years accounting for an additional 30%. These statistics are important because cocaine use can result in acute and chronic pathology involving almost every body organ system and often more than a single organ system at a time. Commonly involved organ systems include the central nervous, cardiovascular, pulmonary, gastrointestinal, and musculoskeletal. The most dramatic complication of cocaine use is sudden death, which can occur after a single-use episode. After completing this CME activity, the radiologist will be able to recognize the emergency department presentations that may be associated with cocaine use, thus leading to a higher level of suspicion of cocaine abuse when a young, relatively healthy patient presents to the emergency department. BackgroundCocaine, an alkaloid derived from the Erythroxylum coca plant, was first introduced in 1884 for its pharmacologic effect of local anesthesia. Cocaine is primarily available as a hydrochloride salt (powder) or free base ("crack") and can be inhaled (snorted/sniffed or smoked), injected, ingested, and chewed.Locally, cocaine blocks electrical impulse transmission by preventing rapid depolarization of the cell membrane via sodium ion influx. Systemically, cocaine exerts action by preventing presynaptic reuptake of norepinephrine, serotonin, and dopamine, which (via norepinephrine) can lead to sympathetic nervous system activation, resulting in arterial and venous vasoconstriction and elevation of blood pressure. Cocaine also increases endothelin-1 (a potent vasoconstrictor) while decreasing nitric oxide (a vasodilator). 1 Cocaine modulates cardiac inotropism (myocyte contractility), dromotropism (atrioventricular node conduction), and chronotropism (heart rate, tachycardia) mainly through ␤-1-receptors. Alphaadrenergic effects are controversial, with some studies demonstrating block of vasospasm with phentolamine or prazosin, and other studies demonstrating block only by diltiazem, the 1 After participating in this activity, the diagnostic radiologist should be better able to evaluate the varied imaging manifestations of cocaine use, particularly those relevant to the emergency department setting.

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Section: Central Nervous System Effectsmentioning

confidence: 97%

Section: Cardiovascular Effectsmentioning

confidence: 99%

Section: Cardiovascular Effectsmentioning

confidence: 99%

Section: Cardiovascular Effectsmentioning

confidence: 99%

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Imaging of Emergency Department Patients With Cocaine Intoxication

2012

Contemporary Diagnostic Radiology

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“…Hypertrophy of the left ventricle and cardiomyopathy with significant reduction of the ejection fraction has been described in the setting of chronic cocaine consumption. Myocardial hypertrophy is likely to occur secondary to the temporary blood pressure elevation after cocaine use [4]. Smoking and alcohol use exacerbate the cardiotoxic impact of cocaine [5].…”

Section: Introductionmentioning

confidence: 99%

Dilated cardiomyopathy secondary to chronic cocaine abuse: a case report

et al. 2013

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BackgroundCocaine is a potent sympathomimetic agent associated with the development of possible fatal cardiovascular complications. Dysrhythmias, acute myocardial infarction, hypertension and dilated cardiomyopathy are just some of many cardiovascular effects related to the abuse of cocaine.Case presentationA 38-year-old Hispanic male with a past medical history of hypertension presented with a chief complaint of progressive shortness of breath. The patient confessed to the use of cocaine for almost 18 years once per week. On examination he was hypertensive and tachycardic with a systolic murmur over the 5th intercostal space at the level of the left mid-clavicular line. Laboratory workup revealed an elevated Brain natriuretic peptide; urine toxicology was positive for cocaine. 2D-echocardiogram showed dilated cardiomyopathy. Cardiac catheterization excluded angioischemic cause. He was managed medically and subsequently discharged with drug rehabilitation. On follow-up diagnostic evaluation after 5 months of cocaine cessation, his ejection function improved significantly.ConclusionThe exact incidence of cocaine related cardiomyopathy is unknown and likely underreported. The clinical course is abrupt and comparatively similar to other types of cardiomyopathy. The management is like other forms of cardiomyopathy; however β-blockers should be avoided. The myocardial dysfunction is reversible with abstaining from additional cocaine ingestion. Non-invasive testing should be performed after several months to re-evaluate the treatment response.

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Cocaine use is associated with cerebral white matter hyperintensities in HIV disease

Meade

Bell

Towe

et al. 2023

Ann Clin Transl Neurol

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BackgroundWhite matter hyperintensities (WMH), a marker of cerebral small vessel disease and predictor of cognitive decline, are observed at higher rates in persons with HIV (PWH). The use of cocaine, a potent central nervous system stimulant, is disproportionately common in PWH and may contribute to WMH.MethodsThe sample included of 110 PWH on antiretroviral therapy. Fluid‐attenuated inversion recovery (FLAIR) and T1‐weighted anatomical MRI scans were collected, along with neuropsychological testing. FLAIR images were processed using the Lesion Segmentation Toolbox. A hierarchical regression model was run to investigate predictors of WMH burden [block 1: demographics; block 2: cerebrovascular disease (CVD) risk; block 3: lesion burden].ResultsThe sample was 20% female and 79% African American with a mean age of 45.37. All participants had persistent HIV viral suppression, and the median CD4+ T‐cell count was 750. Nearly a third (29%) currently used cocaine regularly, with an average of 23.75 (SD = 20.95) days in the past 90. In the hierarchical linear regression model, cocaine use was a significant predictor of WMH burden (β = .28). WMH burden was significantly correlated with poorer cognitive function (r = −0.27). Finally, higher WMH burden was significantly associated with increased serum concentrations of interferon‐γ‐inducible protein 10 (IP‐10) but lower concentrations of myeloperoxidase (MPO); however, these markers did not differ by COC status.ConclusionsWMH burden is associated with poorer cognitive performance in PWH. Cocaine use and CVD risk independently contribute to WMH, and addressing these conditions as part of HIV care may mitigate brain injury underlying neurocognitive impairment.

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Cardiovascular complications of cocaine: Imaging findings

Cited by 33 publications

References 69 publications

Imaging of Emergency Department Patients With Cocaine Intoxication

Imaging of Emergency Department Patients With Cocaine Intoxication

Dilated cardiomyopathy secondary to chronic cocaine abuse: a case report

Cocaine use is associated with cerebral white matter hyperintensities in HIV disease

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