Prevalence of myocardial ischemia in cocaine addicts

The finding that most young cocaine addict patients had a negative exercise treadmill test suggests that they did not have preexisting obstructive coronary artery disease. Noninvasive testing did show, however, that these patients frequently had a high incidence of ST elevation episodes during the first 2 weeks of withdrawal. The pathophysiological mechanism of cocaine-induced cardiovascular disease is not yet clearly understood, but it is probably more complex than the drug's acute direct effects on the cardiovascular system. It may be complicated by fluctuations in catecholamine homeostasis and further temporally complicated by cycles of cocaine use and withdrawal. Research on how cocaine use alters catecholamine homeostasis will increase the understanding of the pathophysiology of cocaine and assist in developing effective pharmacologic and prophylactic treatment for its abuse.