Cocaine and the Heart
Intro
• In 2014: 39,200 million Americans - 12 and older
have admitted to using cocaine at least once in
their life.
• 9,424 million reported using crack-cocaine.
http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpbs
• In 2009, almost one million visits involved an
illicit drug, either alone or in combination with
other types of drugs. DAWN estimates that—
• cocaine was involved in 422,896 ED visits
http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits
Some Good News
• Finally, in 2000, the first significant decline
in cocaine use in several years was
observed; annual prevalence among 12th
graders dropped to 5.0% and then leveled
at about that level through 2007, before
declining again and reaching 2.6% by
2013." - See more at:
http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpuf
Pharmacology
• Cocaine hydrochloride is well absorbed through
all mucous membranes
• As compared to the intravenous route, mucosal
administration results in slower onset of action,
later peak effect and a longer duration of action
• Euphoria is almost immediate after crack
cocaine is smoked
• Crack cocaine is considered the most addictive
form of the drug
Cocaine blocks the reuptake of norepinephrine by the neuron (red X),
resulting in excess amounts of this neurotransmitter at receptor sites on
the effector cell. Short video
CV effects of cocaine:
Ischemia
• Risk of AMI – Acute Myocardial Infarction or
Heart Attack increases 24 fold during the 60
minutes following cocaine use
• There is NO dose-response relationship
between cocaine use and AMI
• Six percent of patients with cocaine-related
chest pain have cardiac enzyme elevation
• Most patients with cocaine-related AMI have no
risk factors except concomitant use of tobacco
Pathogenesis of cocaine related ischemia
What is Ischemia
•Low blood supply to
the bodies organs.
Cocaine and atherosclerosis
Kollodgie et al, JACC 1991:
-Review of 5871 autopsies, 495 subjects with evidence of
cocaine use
-studied degree of atherosclerosis and mean number of
adventitial mast cells per coronary segment
-Results:
-significantly more mast cells in subjects with cocaineassociated thrombosis than in the other age matched groups
-subjects with cocaine-associated thrombosis also had
significant coronary atherosclerosis without plaque
hemorrhage despite a mean age of 29 +/- 2 years
•
http://www.sciencedirect.com/science/article/pii/073510979190646Q
Cocaine and Aortic Dissection
• Aortic dissection or rupture has been
temporally related to cocaine use.
• Arterial dissection probably results from
the substantial increase in systemic
arterial pressure induced by cocaine.
• Also, the cocaine-related rupture of Aortic
aneurysm and intracerebral aneurysms
has been reported.
What do these look like
Cocaine Facial Effects
• If nothing else reaches you
• Know that cocaine will change your face
from the inside.
• YOU DO NOT HAVE TO LOOK AT THE
FOLLOWING SIX SLIDES.
• PICTURES SHOW THE RESULTS OF
USING COCAINE.
Danniela Westbrook
•
Cocaine eats away the septum
Cocaine eats away the structure
of the face
Cocaine eats way the sinus
cavity.