Stimulating Stuff: The Pathological Effects of Cocaine and Amphetamines on the Cardiovascular System

Abstract

P hysicians involved in acute medical take or emergency department work will be well aware of the various acute presentations associated with cocaine and amphetamine use. As the population ages and the heavy users from previous decades accumulate 'crack years', the longer term consequences of these drugs on the cardiovascular system are becoming more evident. This article will review the pharmacology of stimulant drugs and discuss acute and chronic problems associated with their use. Management strategies of acute presentations, including the role of vasodilators in cocaineinduced myocardial infarction, the avoidance of beta-blockers in acute toxicity and the potential role of alpha-2 agonists are discussed. The management of chronic cardiac damage associated with cocaine or amphetamine abuse has an insufficient evidence base to suggest anything other than complete abstinence in combination with well established therapies.

Amphetamine Abuse Related Acute Myocardial Infarction

“…The treatment of AMI attributed to amphetamine abuse is not clearly defined [ 29 , 30 ]. Calcium channel blockers may play an important role in the treatment of AMI due to amphetamines and as in our cases they may be effective in treatment of suspected coronary vasospasm.…”

Acute Myocardial Infarction: Etiologies and Mimickers in Young Patients

“…Mechanisms that lead to cardiac complications with these drugs typically involve vessel damage, prothrombotic effects and direct myocardial injury. 50 In contrast, cocaine may increase myocardial oxygen demand because of increase in blood pressure and heart rate, while also promoting platelet activation 51 or coronary vasospasm, 52 resulting in acute myocardial ischemia. The exact pathophysiological mechanism of AMI following amphetamine use is not well understood but likely because of a combination of coronary vasospasm, intracoronary thrombus formation, and increased myocardial oxygen demand.…”

s Myocardial infarction caused by pharmacological substances – case description and literature review

“…Cocaine users in Europe are estimated at 12 million people [ 38 ]. Mechanisms which lead to cardiac complications after cocaine, amphetamine or ecstasy use are: vessel damage, prothrombotic effect and direct myocardial injury [ 39 ]. Furthermore, increase of oxygen consumption as a consequence of higher blood pressure and heart rate in a situation of simultaneous coronary artery spasm may lead to acute ischemia of cardiac muscle.…”