Last update: April 2020


How does Cocaine give harm to cardiovascular system?

  Cocaine has sympathomimetic effetc due to blockade of presynaptic norepinephrine and dopamine reuptake.

  Cocaine has local anesthetic effect due to sodium channel blockade, similar to Class 1 antiarrhythmic agents. Inhibition of this channel slows impulse conduction (in a manner similar to class I antiarrhythmics), thereby prolonging the QRS and HV intervals.

  Cocaine can block IKr channels (rapid delayed rectifier potassium currents) resulting in QT interval prolongation.



About the effects of Cocaine use

  Cocaine use has acute, chronic and withdrawal effects.

  Cardiovascular effects of Cocaine are dose-dependent, which may account for much of the conflicting data to date.

  Concurrent drug use with Cocaine (alcohol, marijuana, methadone, etc.) may be present.



ECG abnormalities reported after Cocaine use

  Any type of atrioventricular (AV) block.

  ST segment elevation: More frequent than ST depression. May be asymptomatic.

  ST segment depression.

  Negative T waves (most common), flattened T waves, prominent T waves (least common)

  J waves.

  U waves.

  Widened QRS (rare).

  Prolonged QT interval

  Right bundle branch block (more common) or left bundle branch block.

  Brugada pattern (commonly associated with acidosis).



Arrhythmias reported after Cocaine use

  Sinus tachycardia

  Sinus bradycardia

  Sinus arrest

  Ectopic atrial rhythm

  Accelerated junctional rhythm

  Atrial fibrillation

  Supraventricular tachycardia

  Wide QRS tachycardia

  Torsades de Pointes

  Asystole

  Ventricular fibrillation



ECG abnormalities reported during Cocaine withdrawal

  Frequent episodes of ST segment elevation by ambulatory ECG (rhythm Holter) monitoring was observed during the first 2 weeks of Cocaine withdrawal. Most of these episodes were silent.



References

  Int J Mol Sci. 2019 Jan 29;20(3). pii: E584. (free full-text)

  Tex Heart Inst J 2018;45:273-274.

  Expert Rev Cardiovasc Ther 2012;10:105-127.

  Am J Emerg Med 2011;29:245.e3-5.

  Ann Emerg Med 2007;49:827-829.

  J Electrocardiol 2001;34:345-349.

  Am J Med Sci 2000;320:9-12.

  Ann Intern Med 1989;111:876-880.