Which cardiovascular findings are characteristic of cocaine toxicity?

Updated: Dec 31, 2020
  • Author: Lynn Barkley Burnett, MD, EdD, JD; Chief Editor: Sage W Wiener, MD  more...
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Cardiopulmonary complaints are the most common presenting manifestations of cocaine abuse and include chest pain (frequently observed in long-term use or overdose), MI, arrhythmia, and cardiomyopathy.

In individuals with cocaine-associated MI, median times to the onset of chest pain vary with the route or form of cocaine use: 30 minutes for intravenous use, 90 minutes for crack, and 135 minutes for intranasal use.

Chest pain may be observed in as many as 40% of patients presenting to the ED after admitting to cocaine use. In a study of urban and suburban EDs, cocaine or its metabolites were found in 17% of patients presenting with chest pain. This starkly contrasts with the pretest estimated prevalences of 2-4% for the suburban study site and 10% for the urban sites. The mean age of patients with chest discomfort and positive assays for cocaine was 36 years.

Cocaine and other stimulant use should be included in the differential diagnosis of any acute vascular problem. The long-term outcome of patients presenting with chest pain associated with cocaine use is comparable to patients presenting with “conventional” chest pain. [30]

Vascular spasm may cause blindness, renal infarction, limb ischemia, and intestinal ischemia. Accelerated atherogenesis and thrombosis of the superior mesenteric artery have been reported with chronic cocaine use. [37] Limb ischemia may occur after intra-arterial injection, which may be done inadvertently, or be intentional due to the unavailability of veins because of sclerosis secondary to repetitive puncture, or due to the desired effects from arterial injection.

Other cardiovascular findings include the following:

  • Dysrhythmia (premature ventricular contractions [PVCs], supraventricular tachycardia [SVT], ventricular tachycardia [VT], and ventricular fibrillation [VF])

  • Vasomotor collapse

  • High-output heart failure

  • Aortic dissection

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