Cocaine in acute myocardial infarction (2010)

Cocaine, a crystalline tropane alkaloid which is obtained from the leaves of the coca plant, acts a powerfully addictive stimulant that directly targets the central nervous system. The effects of the drug appear almost immediately after a single dose (intravenous, intranasal, or inhaled), and disappear within a few minutes or hours. Although the free commercialization of the drug is illicit and severely penalized in virtually all countries, its use remains widespread in many social, cultural, and personal settings. There is a variety of well-recognized side effects of cocaine abuse, which involve virtually every organ system. There is also emerging evidence, however, that cocaine abuse might trigger a variety of cardiac disorders, ranging from arrhythmias to acute myocardial infarction (AMI), heart failure and even sudden cardiac death, especially in relatively young male patients (e.g., those in the mid-1930s), in those who concomitantly use tobacco and alcohol, in those having experienced a trauma or a car accident and lack traditional risk factors for atherosclerosis. Since the use of cocaine may influence the treatment strategies of patients being evaluated for possible acute coronary syndrome (ACS) as well as the prognosis of an AMI, it might be advisable to introduce cocaine screening in patients admitted with chest pain at the emergence department, especially in high-risk patients (i.e., young males with concurrent use of tobacco or alcohol, suffering from a recent accident and with no traditional atherosclerotic risk factors), or in those who are unresponsive and unreliable. This strategy might be helpful to adopt the best therapeutic approach for reducing the risks associated with cardiovascular disease in these patients, and also to deter relapse.