Myocardial ischemia during cocaine withdrawal.

Abstract:

STUDY OBJECTIVE:To determine the prevalence of myocardial ischemia in patients with cocaine addiction. DESIGN:Myocardial ischemia in chronic cocaine users was detected by serial 24-hour electrocardiographic ambulatory (Holter) monitoring and exercise treadmill testing in chronic cocaine users. The Holter tapes were coded, scanned in a blinded manner, and mixed with the tapes of 42 normal volunteers and 119 patients with either stable or unstable angina. SETTING:A 28-day inpatient, substance abuse treatment program followed by an outpatient treatment program. PATIENTS:Twenty-one consecutive male chronic cocaine users. MAIN RESULTS:Eight of the 21 patients with cocaine addiction had frequent episodes of ST elevation during Holter monitoring; these episodes occurred almost exclusively during the first 2 weeks of withdrawal. None of the volunteers and patients with stable angina and only 4% of the patients with unstable angina had episodes of ST elevation during Holter monitoring (cocaine users compared with volunteers, P = 0.0004). Of the 20 cocaine patients who had exercise treadmill testing, only 1 had a positive test for ischemia. CONCLUSIONS:Cocaine users frequently develop silent myocardial ischemia manifesting as episodes of ST elevation during the first weeks of withdrawal. The underlying mechanisms for these changes remain unknown, but our observations support the hypothesis that coronary vasospasm plays an important role in cocaine-related ischemic syndromes.

journal_name

Ann Intern Med

authors

Nademanee K,Gorelick DA,Josephson MA,Ryan MA,Wilkins JN,Robertson HA,Mody FV,Intarachot V

doi

10.7326/0003-4819-111-11-876

subject

Has Abstract

pub_date

1989-12-01 00:00:00

pages

876-80

issue

11

eissn

0003-4819

issn

1539-3704

journal_volume

111

pub_type

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