Cocaine-induced myocardial infarction in patients with normal coronary arteries

Article Abstract:

Cocaine is a dangerous illicit drug that has been linked to a variety of cardiovascular complications. Acute myocardial infarction (AMI; heart attack) has been identified as the most common cardiovascular event resulting from cocaine use. Particularly troubling are the many reports linking cocaine use to AMI in young people and others with apparently normal coronary arteries (compared with the atherosclerotic blockages normally found in AMI victims). The mechanism underlying AMI in individuals with normal coronary arteries is unclear, but may involve vasospasm (acute constriction of the vessels supplying blood to the heart and thrombosis, or blood clotting within vessels). To review what is known about cocaine-induced AMI in patients with normal coronary arteries, the computer data bases MEDLINE and Index Medicus, and bibliographies of case reports were perused, and three additional new cases of this nature were described. A total of 114 cases of cocaine-induced AMI were identified; in 38 percent of these cases the coronary arteries were normal, as determined by angiography (in still-living patients) or by autopsy. This subset of patients had an average age of 32 years (range 21 to 60 years). Moderate or heavy cigarette smoking was common in this group of patients; however, not more than one coronary risk factor, other than smoking, was usually present. Recent experimental evidence suggests that cocaine may mimic the effects of the sympathetic nervous system on cardiac muscle, blunt the ability of the endothelium (lining of blood vessels) to dilate, and exert a potent depressive effect on myocyte (cardiac muscle fiber) contractility. (Consumer Summary produced by Reliance Medical Information, Inc.)

Coronary arteries

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Cocaine and chest pain: clinical features and outcome of patients hospitalized to rule out myocardial infarction

Article Abstract:

In recent years, a number of severe medical complications have been associated with the use of cocaine, including seizure, myocardial infarction (heart attack), and death. When a cocaine-abusing patient comes to an emergency room complaining of chest pain, he or she is presumed to be experiencing heart damage until blood tests and electrocardiograms prove otherwise. A study was done to determine the frequency of heart attack among cocaine-abusing patients who complained of chest pain and were admitted through the emergency room of a Minneapolis county hospital. A total of 101 admissions were evaluated. The patients' average age was 31.5 years, 70 percent were black, and 23 percent were women. An independent cardiologist evaluated the electrocardiograms for each of these patients, and found only eight to be suggestive of acute damage to the heart. None of the patients had blood test results that were suggestive of cardiac damage. The average cost of hospitalizing these patients until heart damage was ruled out was nearly $2000. No patient was ultimately found to have suffered a heart attack as a result of cocaine abuse. This study shows that cocaine-induced chest pain is an uncommon cause of heart attack. Furthermore, the findings at least suggest that a normal electrocardiogram probably excludes the possibility of heart attack. (Consumer Summary produced by Reliance Medical Information, Inc.)

Chest pain

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Possible bromocriptine-induced myocardial infarction

Article Abstract:

Heart attacks may be induced in women who take the drug bromocriptine following childbirth. A 32-year-old woman who had an uncomplicated pregnancy and normal delivery began taking bromocriptine to suppress lactation. She developed severe headaches and began hallucinating. These symptoms subsided when she did not take the drug for one day. When she resumed taking bromocriptine, the symptoms returned and she experienced severe chest pain. Tests confirmed that she had a heart attack. One month after her release from the hospital, the woman consented to undergo a bromocriptine test and her reaction was monitored. While she did not experience any chest pain, angiography revealed a severe narrowing of her right coronary artery that disappeared after nitroglycerin was administered.

Health aspects, Bromocriptine

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