Cocaine may cause cardiac disease by a number of mechanisms, including coronary artery vasospasm, arterial vasoconstriction, thrombosis and direct toxicity to myocytes. It is important to consider cocaine-induced heart disease when a person presents with an unexplained cardiac condition, since the disorder is preventable and a different approach may be needed in working with the patient.


When to consider cocaine as a cause for a cardiac syndrome:

(1) history or laboratory evidence of cocaine use

(2) unexplained symptoms or signs of heart failure

(3) unexplained global or focal myocardial dyskinesia on echocardiogram

(4) acute coronary syndrome in a patient with angiographically normal coronary arteries

(5) sudden death in a young adult


The occurrence of unexplained heart disease in a young person might trigger consideration of cocaine use sooner than in an older person, where abuse of cocaine might go unrecognized.


The differential diagnosis in a young person includes quite a few conditions, so that age alone should not be the sole criteria for diagnosis:

(1) coronary artery vasospasm (angiographically normal coronary arteries)

(2) cardiomyopathy

(3) anomalous coronary artery

(4) vasculitis


Once the diagnosis has been introduced, a workup might include:

(1) hair analysis for drugs

(2) a more aggressive drug history with the patient

(3) discrete inquiries of family and friends

(4) drug screening at the time of presentation with another episode of heart disease


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