Myocardial ischemia during cocaine withdrawal
K Nademanee1, D A Gorelick, M A Josephson
1West Los Angeles Veterans Administration Medical Center, California.
Annals of Internal Medicine
|December 1, 1989
Summary
Cocaine addiction frequently leads to silent myocardial ischemia, particularly during early withdrawal. This study highlights ST elevation episodes in cocaine users, suggesting coronary vasospasm may be a key factor.
Area of Science:
- Cardiology
- Toxicology
- Substance Abuse Research
Background:
- Cocaine use is associated with cardiovascular complications.
- The prevalence of myocardial ischemia in cocaine-dependent individuals is not well-defined.
Purpose of the Study:
- To determine the frequency of silent myocardial ischemia in patients with cocaine addiction.
Main Methods:
- Utilized 24-hour ambulatory electrocardiographic (Holter) monitoring and exercise treadmill testing.
- Compared 21 male chronic cocaine users with 42 healthy volunteers and 119 patients with angina.
Main Results:
- Eight of 21 cocaine users exhibited ST elevation during Holter monitoring, primarily in the first two weeks of withdrawal.
- Cocaine users showed significantly more ST elevation episodes than volunteers (P = 0.0004).
- Only one cocaine user had a positive exercise treadmill test for ischemia.
Conclusions:
- Cocaine users frequently experience silent myocardial ischemia, indicated by ST elevation, especially during early withdrawal.
- Coronary vasospasm is hypothesized as a significant contributor to cocaine-related ischemic events.
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