The heart problems caused by sustained cocaine abuse are highlighted in a Case Report published in this week's edition of The Lancet.
The report focuses on a 31-year-old Italian man who turned up at the Emergency Department of the Siena General Hospital during 2005 suffering chest pain, dyspnoea and fatigue. He had no previous medical history but admitted longstanding cocaine misuse. Dr Valerio Zacà and colleagues at the hospital treated the man and authored this Case Report.
Tests revealed the left ventricle in the patient's heart had dilated to 80mm. The heart was also moving weakly and was not contracting properly. He was subsequently diagnosed with dilated cardiomyopathy (swollen heart with damaged muscle) caused by cocaine misuse.
He was discharged on a regimen of drugs including warfarin, and in the months following received drug counselling and tested negative for cocaine at a series of unscheduled urine tests. He reported back for further tests in September 2006 and his left ventricular diameter had reduced to 57mm, and the contractile function of the heart was also much improved.
In recent years, cocaine use has risen to epidemic proportions in the USA and Europe. The observation of cardiovascular complications associated with cocaine use has become progressively more frequent.
The authors say: "A history of cocaine use should be considered when assessing previously healthy young patients with heart disease."
They add that cocaine is well known to cause myocardial ischaemia (shortage of blood to the heart) and infarction (death of heart muscle). There is also evidence of an increase prevalence of left ventricular systolic dysfunction in long term cocaine abusers.
The drug also causes microscopic changes similar to those observed in patients with phaeochromocytoma (a tumour of the adrenal gland which causes excess adrenaline production, leading to heart palpitations and other symptoms).
The authors conclude: "Debate continues over whether, and how, cardiomyopathy caused by cocaine use can resolve on abstinence. We hypothesise that abstinence allows recovery from sympathetic overstimulation, rather like surgical removal of a phaeochromocytoma."
Journal
The Lancet