In Australia, the lifetime use of cocaine is rising, with 3% of the population aged over 14 using cocaine in 1991, increasing to 4.5% in 1998, and cocaine use accounting for 10% of all deaths secondary to illicit drug use in 1998.
Cocaine is prepared from the leaves of the plant Erythroxylon coca, and is available as cocaine hydrochloride (a water-soluble powder or granule which can be taken orally, intravenously or intranasally) and as "freebase" or "crack" cocaine (heat stable, melting at high temperatures, thus allowing it to be smoked).
Acute myocardial infarction (AMI) is the most commonly reported cardiac consequence of cocaine misuse, usually occurring in men who are young, fit and healthy and who have minimal, if any, risk factors for cardiovascular disease.
The mechanism by which cocaine induces AMI is largely not understood.
Cocaine effect should be seriously considered in any young patient with minimal risk factors for cardiac disease presenting with AMI, dilated cardiomyopathy, myocarditis or cardiac arrhythmias.
- 1. Miller M, Draper G. Statistics on drug use in Australia. Canberra: Australian Institute of Health and Welfare, 2000. <www.aihw.gov.au>.
- 2. Mouhaffel AH, Madu EC, Satmary WA, Fraker T. Cardiovascular complications of cocaine. Chest 1995; 107: 1426-1434.
- 3. Lange RA, Hillis LD. Cardiovascular complications of cocaine use. N Engl J Med 2001; 345: 351-357.
- 4. Mycek MJ, Harvey RA, Champe PC, editors. Lippincott's illustrated reviews: Pharmacology. 2nd ed. Philadelphia: Lippincott Williams and Wilkins, 2000.
- 5. Zimmerman FH, Gustafson GM, Kemp HG Jr. Recurrent myocardial infarction associated with cocaine abuse in a young male with normal coronary arteries: evidence for coronary artery spasm culminating in thrombosis. J Am Coll Cardiol 1987; 9: 964-968.
- 6. Hollander JE, Hoffman RS, Burstein JL, et al. Cocaine associated myocardial infarction: mortality and complications. Arch Intern Med 1995; 155: 1081-1086.
- 7. Mittleman MA, Mintzer D, Maclure M, et al. Triggering of myocardial infarction by cocaine. Circulation 1999; 99: 2737-2741.
- 8. Cheung, TO. Risk of acute myocardial infarction in cocaine abusers [letter]. Circulation 2000; 101: 227.
- 9. Amin M, Gabelman G, Karpel J. Acute myocardial infarction and chest pain syndrome after cocaine use. Am J Cardiol 1990; 66: 1434-1437.
- 10. Heesch CM, Eilhelm CR, Ristich J, et al. Cocaine activates platelets and increases the formation of circulating platelet containing microaggregates in humans. Heart 2000; 83: 688-695.
- 11. Kolodgie FD, Farb A, Virmany R. Pathobiological determinants of cocaine associated cardiovascular syndromes. Hum Pathol 1995; 26: 583-586.
- 12. Wilbert-Lampen U, Selinger C, Zilker T, Arendt R. Cocaine increases the endothelial release of immunoreactive endothelin and its concentrations in human plasma and urine: reversal by co-incubation with sigma-receptor antagonists. Circulation 1998; 98: 385-390.
- 13. Vongpatanasin W, Mansour Y, Chavoshan B, et al. Cocaine stimulates the cardiovascular system via a central mechanism of action. Circulation 1999; 100: 497-502.
- 14. Chokshi SK, Moore R, Pandian NG. Reversible cardiomyopathy associated with cocaine intoxication. Ann Intern Med 1998; 111: 1039-1040.
- 15. Qureshi AJ, Fareed M, Suri K, et al. Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey. Circulation 2001; 103: 502-506.
- 16. Hollander JE. Current concepts: the management of cocaine-associated myocardial ischaemia. N Engl J Med 1995; 333: 1267-1272.
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