Drugs of Abuse and Cardiotoxicity

Abstract

This chapter features the cardiovascular toxicity profiles of the most common drugs of abuse encountered in the practice of adult cardiology and emergency medicine. Cocaine is the second most frequently used illicit drug in the United States after marijuana. Cocaine abuse is associated with chest pain, myocardial infarction (MI), heart failure, arrhythmias, and premature coronary atherosclerosis. Long-term alcohol abuse is also associated with cardiac systolic dysfunction, arrhythmias, and hypertension, but when consumed in moderation appears to confer cardiovascular health benefits. Abstinence can reverse many of these adverse effects. Opiates (particularly heroin abuse) are associated with arrhythmias and noncardiogenic pulmonary edema. Amphetamine use has been associated with MI and cardiomyopathy, while cardiotoxic effects resulting from chronic marijuana (or cannabis) use are relatively infrequent. The issue of whether caffeine increases the risk of coronary artery disease (CAD) and stroke remains controversial.