Cardiac complications of cocaine abuse

AbstractCardiac complications of cocaine abuse and a rational approach to evaluating and managing them are described. Cardiac abnormalities reported among asymptomatic cocaine abusers include echocardiographic left ventricular hypertrophy and segmental wall motion abnormalities. Electrocardiogram may reveal increased QRS voltage, ST‐T changes, and pathologic Q waves. Episodes of ST elevation may be seen during Holter monitoring. The management of cocaine‐abusing patients who present to an emergency room with acute chest pain is controversial because the two reported studies yielded conflicting results regarding the incidence of myocardial infarction (MI). Even in the absence of infarction, electrocardiographic abnormalities are common among these patients, which complicates the decision‐making regarding hospitalization. Pathophysiology of cocaine‐related MI is discussed. Distinct clinical features of cocaine‐related MI make it clear that the association between the two is not just temporal. However, considering the number of persons abusing cocaine, it is a rarity. Beta‐adrenergic blockers should be avoided in the treatment of cocaine‐induced myocardial ischemia which is best treat