What are the side effects of cocaine use?

Side Effects of Cocaine

Cocaine use causes severe cardiovascular complications including myocardial infarction, arrhythmias, coronary vasospasm, and sudden death through multiple mechanisms including increased myocardial oxygen demand, decreased oxygen supply, and prothrombotic effects. 1

Cardiovascular Effects

Cocaine affects the cardiovascular system through several mechanisms:

1. Increased myocardial demand:

   • Dose-dependent increases in heart rate (17-16% beats/min)
   • Elevated blood pressure (8-7% mm Hg)
   • Increased cardiac index (18-18% L/min per m²) 1

2. Decreased oxygen supply:

   • Coronary vasoconstriction (even with small intranasal doses)
   • Stimulation of α-adrenergic receptors in coronary arteries
   • Increased endothelin-1 (vasoconstrictor)
   • Decreased nitric oxide (vasodilator) 1

3. Prothrombotic effects:

   • Increased plasminogen-activator inhibitor
   • Elevated platelet count and activation
   • Enhanced platelet aggregability
   • Elevated levels of C-reactive protein, von Willebrand factor, and fibrinogen 1

4. Accelerated atherosclerosis:

   • Premature coronary atherosclerosis observed in autopsy studies 1

Myocardial Infarction Risk

• 0.7-6% of patients presenting with chest pain after cocaine use experience MI 1
• Risk is higher in urban populations and those with pre-existing coronary disease 1

Neurological Effects

• Pupillary dilation (mydriasis) due to sympathomimetic activity
• Occurs through blockade of norepinephrine and dopamine reuptake
• Can precipitate acute angle-closure glaucoma in predisposed individuals 2
• Other sympathomimetic effects include agitation and hyperthermia 2

Respiratory Effects

• Various respiratory problems associated with crack inhalation
• Changes in respiratory tract from both local and systemic effects
• Complications vary based on method of administration (smoking, sniffing, injecting) 3

Other Organ Systems

• Renal damage: Documented cases of renal failure from cocaine abuse 3
• Hepatotoxicity: Mediated by oxidative stress and mitochondrial dysfunction 3
• Fetal effects: High incidence of congenital cardiovascular and brain malformations in offspring of mothers who used cocaine 3

Clinical Presentation of Cocaine Toxicity

Typical characteristics of patients with cocaine-related chest pain or MI include:

• Young age (usually under 40)
• Male gender
• Cigarette smoker
• Symptom onset minutes to hours after cocaine use
• Can occur with any route of administration and with small or large doses
• Often associated with concomitant alcohol or tobacco use 1

Important Considerations

1. Synergistic effects:

   • Combined cocaine and cigarette use causes greater increases in heart rate and vasoconstriction than either alone 1
   • Alcohol intensifies the chronotropic effects of cocaine 1

2. Misconceptions:

   • Cocaine toxicity is not limited to intravenous use; intranasal use is equally dangerous
   • Underlying heart disease is not required for cocaine-related cardiac events
   • Serious cardiac complications can occur even with small doses 4

3. Treatment challenges:

   • Beta-blockers are controversial and may worsen coronary blood flow
   • Calcium channel blockers, alpha-blockers, and nitrates show promise for acute toxicity 5
   • Benzodiazepines are recommended for initial management of cocaine-induced cardiovascular toxicity 6

The cardiovascular complications of cocaine use represent a significant medical emergency requiring prompt recognition and appropriate management to prevent morbidity and mortality.