Dilated cardiomyopathy secondary to chronic cocaine abuse: a case report

Abstract

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.

Cardiovascular consequences of cocaine use

“…Others have reported signs of cardiovascular damage, including increased systolic blood pressure, aortic stiffness, increased left ventricular mass, and bradycardia, in otherwise healthy young individuals who chronically use cocaine [32][33][34]. This chronic cardiovascular damage results in an increased risk of the acute coronary syndromes described above as well as risks for diseases associated with ongoing myocardial cell death and atherosclerotic processes, such as cardiomyopathy [48][49][50][51] and endocarditis.…”

Acute and Chronic Effects of Cocaine on Cardiovascular Health

“…It may cause non-ischemic myocardial depression, leading to dilated cardiomyopathies such as Takotsubo cardiomyopathy, a type of non-ischemic cardiomyopathy [50]. Previous studies reported that cocaine-induced cardiomyopathy, especially dilated cardiomyopathy [51,52], resulting from deprivation of myocardial oxygen supply despite increased demand for oxygen, leads to reduced coronary blood flow. Dilated cardiomyopathy is the most common consequence of long-term cocaine use and can lead to several complications including heart failure and heart-valve defects [53].…”

Cocaine-Induced Coronary Syndromes: Unraveling the Complex Pathophysiology and Clinical Implications

“…Additionally, cocaine-induced myocardial ischemia can lead to acute decompensated heart failure, exacerbating hemodynamic instability and increasing the risk of cardiogenic shock [32]. Sudden cardiac death is a devastating complication associated with cocaine use, often attributed to fatal arrhythmias or acute coronary events, highlighting the importance of early recognition and aggressive management of cocaine-induced coronary syndromes to mitigate adverse outcomes [33].…”