Acute Cardiac Events Temporally Related to Cocaine Abuse

The increasingly widespread use of cocaine in the United States has been accompanied and perhaps exacerbated by the misconception that the drug is not associated with serious medical complications. In particular, the potential for cocaine to precipitate life-threatening cardiac events needs to be reemphasized. We report the clinical and pathological findings in seven people in whom nonintravenous “recreational” use of cocaine was temporally related to acute myocardial infarction, ventricular tachycardia and fibrillation, myocarditis, sudden death, or a combination of these events. We also review data on 19 previously reported cases of cocainerelated cardiovascular disorders. Analysis of all 26 patients indicated the following findings: (1) the cardiac consequences of cocaine abuse are not unique to parenteral use of the drug, since nearly all the patients took the drug intranasally; (2) underlying heart disease is not a prerequisite for cocaine-related cardiac disorders; (3) seizure activity, a well-documented noncardiac complication of cocaine abuse, is neither a prerequisite for, nor an accompanying feature of, cardiac toxicity of cocaine; and (4) the cardiac consequences of cocaine are not limited to massive doses of the drug. Although the pathogenesis of cardiac toxicity of cocaine remains incompletely defined, available circumstantial evidence suggests that cocaine has medical consequences that are equal in importance to its well-documented psychosocial consequences. (N Engl J Med 1986; 315:1438–43.), “RECREATIONAL” use of cocaine in the United JLV States has reached epidemic proportions; 22 million, or 1 in 10, Americans report that they have used cocaine at least once,^1,2 and 5 million reportedly use it regularly.³ Despite previous reports documenting cocaine's ability to precipitate cardiovascular events, there remains “among many physicians… an entirely mistaken notion that coke taken by [the intranasal] route is safe.”² Furthermore, even in these reports, few data are available on the pathological findings in cases of cocaine-related cardiac toxicity. This report summarizes the clinical and pathological findings in seven people in whom a cardiac…