Influence of Cocaine, Ethanol, or Their Combination on Epicardial Coronary Arterial Dimensions in Humans

Pirwitz, Mark J.; Willard, John E.; Landau, Charles; Lange, Richard A.; Glamann, D.Brent; Kessler, David J.; Foerster, E. H.; Todd, Elizabeth L.; Hillis, L.David

doi:10.1001/archinte.1995.00430110100011

Cited by 30 publications

(4 citation statements)

References 43 publications

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“…Co-use of ethanol was predominant in the present and in the previously studied series of cocaine intoxications [2]. Ethanol co-use with cocaine forms cocaethylene but also increases the plasma levels of cocaine, cocaine-induced subjective and also its cardiostimulant effects [30-32]. Ethanol may therefore increase the toxicity of cocaine [31,33] consistent with our findings.…”

Section: Discussionsupporting

confidence: 88%

Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series

et al. 2014

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BackgroundEmergency departments may be a useful information source to describe the demographics and clinical characteristics of patients with acute cocaine-related medical problems. We therefore conducted a retrospective analysis of 165 acute, laboratory-confirmed cocaine intoxications admitted to an urban emergency department in Switzerland between January 2007 and March 2011.ResultsA total of 165 patients with a mean age of 32 years were included. Most patients were male (73%) and unemployed (65%). Only a minority (16%) had abused cocaine alone while 84% of the patients had used at least one additional substance, most commonly ethanol (41%), opioids (38%), or cannabis (36%) as confirmed by their detection in blood samples. The most frequently reported symptoms were chest pain (21%), palpitations (19%), anxiety (36%) and restlessness (36%). Psychiatric symptoms were present in 64%. Hypertension and tachycardia were observed in 53% and 44% of the patients, respectively. Severe poisonings only occurred in patients with multiple substance intoxication (15%). Severe intoxications were non-significantly more frequent with injected drug use compared to nasal, oral, or inhalational drug use. Severe complications included acute myocardial infarction (2 cases), stroke (one case), and seizures (3 cases). Most patients (75%) were discharged home within 24 h after admission. A psychiatric evaluation in the ED was performed in 24% of the patients and 19% were referred to a psychiatric clinic.ConclusionsPatients with acute cocaine intoxication often used cocaine together with ethanol and opioids and presented with sympathomimetic toxicity and/or psychiatric disorders. Severe acute toxicity was more frequent with multiple substance use. Toxicity was typically short-lasting but psychiatric evaluation and referral was often needed.

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Section: Discussionsupporting

confidence: 88%

Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series

et al. 2014

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“…Indeed, patients with chest pain, who were referred for catheterization and were given intranasal cocaine (2 mg/kg) plus alcohol (5 mL/kg), showed an increased myocardial oxygen demand of 17% and 16% at 30 and 90 min, respectively, with a concomitant increase of the coronary arterial diameter by 7% and 13%, respectively, whereas in patients who were given cocaine only, the myocardial oxygen demand increased by 5% and 10%, respectively. Surprisingly, and in contrast to previous findings showing coronary vasoconstriction by intranasal cocaine [ 51 , 52 ], the coronary artery diameter increased by 14% at the same time points [ 53 ]. This is of interest because coronary artery vasoconstriction would further impair the oxygen supply to the heart [ 51 ].…”

Section: Resultscontrasting

confidence: 99%

“…Confusingly, on the one hand, CE was reported with both a lower [ 70 ] and a higher association with myocardial injury [ 71 ]. On the other hand, CE was reported to induce higher cardiotoxicity [ 53 ], higher rates of cardiac arrest and hyperlactatemia [ 70 ], higher admission to the ICU [ 72 , 73 ], and higher mortality in other studies [ 46 , 77 ].…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

van Amsterdam,

Gresnigt,

van den Brink

2024

JCM

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Background: The simultaneous use of cocaine and alcohol is highly prevalent and is associated with high numbers of emergency department admissions, primarily due to cardiovascular complications. Aims: To answer the question of whether the co-use of cocaine and alcohol increases the cardiovascular risk compared to the use of cocaine alone. Method: A systematic review of human studies comparing the cardiovascular risk of co-used cocaine and alcohol with the use of cocaine alone. Results: Despite a higher myocardial workload induced by the co-use of cocaine and alcohol and the potentiation of cocaine’s cardiovascular effects by alcohol, the findings on the risk and severity of cardiovascular symptoms due to combined use are inconsistent. However, the co-use of cocaine and alcohol clearly leads to higher mortality. Interestingly, the presence of cocaethylene, a unique metabolite generated only via a pharmacokinetic interaction between alcohol and cocaine, carries an 18- to 25-fold increase over the absence of cocaethylene (cocaine-alone users) in the risk of sudden death and is associated with myocardial injury and cardiac arrest, probably due to the inhibition of cardiac ion channels by cocaethylene. Conclusion: Despite the inconsistency in some of the results, it is concluded that the co-use of cocaine and alcohol poses an additional risk of cardiovascular fatalities compared to the use of cocaine alone.

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“…The combined use of ethanol and cocaine has been most frequently found in emergency departments and it can produce deleterious cardiovascular effects [95]. The combined use of ethanol and cocaine has been most frequently found in emergency departments and it can produce deleterious cardiovascular effects [95].…”

Section: P1 Alcoholmentioning

confidence: 99%

Illicit drugs and cardiac arrhythmias in athletes

Furlanello

Serdoz

Cappato

et al. 2007

European Journal of Cardiovascular Prevention & Rehabilitat

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The current management of athletes with cardiac arrhythmias has become complicated by the widespread use of illicit drugs, which can be arrhythmogenic. The World Anti-Doping Agency annually updates a list of prohibited substances and methods banned by the International Olympic Committee that includes different classes of substances namely, anabolic androgenic steroids, hormones and related substances, beta2-agonists, diuretics, stimulants, narcotics, cannabinoids, glucocorticosteroids, alcohol, beta-blockers and others. Almost all illicit drugs may cause, through a direct or indirect arrhythmogenic effect, a wide range of cardiac arrhythmias (focal or reentry type, supraventricular and/or ventricular) that can even be lethal and which are frequently sport activity related. A large use of illicit drugs has been documented in competitive athletes, but the arrhythmogenic effect of specific substances is not precisely known. Precipitation of cardiac arrhythmias, particularly in the presence of a latent electrophysiologic substrate including some inherited cardiomyopathies, at risk of sudden death or due to long-term consumption of the substances, should raise the suspicion that illicit drugs may be a possible cause and lead cardiologists to investigate carefully this relationship and appropriately prevent the clinical consequences.

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Influence of Cocaine, Ethanol, or Their Combination on Epicardial Coronary Arterial Dimensions in Humans

Abstract: The combination of intranasal cocaine and intravenous ethanol causes an increase in the determinants of myocardial oxygen demand. However, it also causes a concomitant increase in epicardial coronary arterial diameter.

Cited by 30 publications

References 43 publications

Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series

Acute cocaine-related health problems in patients presenting to an urban emergency department in Switzerland: a case series

Cardiovascular Risks of Simultaneous Use of Alcohol and Cocaine—A Systematic Review

Illicit drugs and cardiac arrhythmias in athletes

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