Abstract
Long-term cocaine use, as well as acute cocaine use, is associated with adverse cardiovascular consequences, including arrhythmias, angina, myocardial infarction, heart failure, and other conditions. Over the long term, cocaine can result in structural changes to the heart such as increased left-ventricular mass and decreased left-ventricular end-diastolic volume. Patients arriving with cocaine-associated cardiovascular complaints may not be forthcoming about their cocaine or polysubstance abuse or may be unresponsive. The role of beta-blockers, a first-line treatment for many forms of heart disease, is controversial in this population. Cocaine is a powerful sympathomimetic agent, and it was thought that beta-blockade would result in unopposed alpha-adrenergic stimulation and adverse consequences. A number of small, single-center, retrospective and observational studies suggest that beta-blockers may be safe, effective, and beneficial in this population. Further study is needed to clarify the role of beta-blockers in this population.
Highlights
BackgroundCocaine, one of the most frequently consumed recreational drugs, can cause irreversible structural damage to the heart, accelerate cardiovascular disease processes, and trigger arrhythmias and other cardiovascular conditions [1]
Cocaine is the main cause for drug-related visits to the emergency room, and most of these are for cardiovascular problems [2]
Most clinical encounters with cocaine-associated cardiovascular conditions occur in emergency medicine with acute conditions in young patients with few apparent risk factors for heart disease
Summary
One of the most frequently consumed recreational drugs, can cause irreversible structural damage to the heart, accelerate cardiovascular disease processes, and trigger arrhythmias and other cardiovascular conditions [1]. Most clinical encounters with cocaine-associated cardiovascular conditions occur in emergency medicine with acute conditions (chest pain, myocardial infarction, arrhythmias) in young patients with few apparent risk factors for heart disease. This paradoxical patient with a cardiovascular emergency may be experiencing cocaine-associated complications. This study evaluated patients with heart failure, which is not the only clinical cardiovascular manifestation of long-term cocaine use Another consideration is whether or not some beta-blockers may be better than others for cocaine users with cardiovascular disease. Further study is needed to answer more questions: are beta-blockers safe and effective for people actively using cocaine? Can we quantify their risks and their morbidity and mortality benefits? Are particular beta-blockers or treatment regimens safer and more effective than others for this population?
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