Cocaine is responsible for more emergency department visits than any other drug of abuse except alcohol. Chest pain is the most common presenting symptom in these patients. Due to sympathomimetic effects that simultaneously increase oxygen demand (via increased heart rate and blood pressure) and limit coronary blood supply (via coronary vasoconstriction, accelerated atherosclerosis, and thrombosis), even small amounts of cocaine can trigger myocardial ischemia or infarction. Concomitant smoking and cocaine use increase the risk of myocardial ischemia or infarction. Alpha-adrenergic agents such as phentolamine can alleviate the inappropriate vasoconstriction while beta-blockers such as propranolol aggravate it. First-line agents for treating cocaine-related ischemia or infarction include oxygen, aspirin, nitroglycerine, and benzodiazepines. Second-line agents are verapamil, phentolamine, and - in carefully selected cases - thrombolytic agents. Propranolol should be avoided in these patients. Because primary care physicians are likely to encounter patients who abuse cocaine, understanding the relationship between cocaine use and myocardial ischemia will be essential for the early recognition and proper management of this common and potentially lethal condition.
|Original language||English (US)|
|Journal||Advanced Studies in Medicine|
|State||Published - Sep 1 2003|
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