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Cocaine And Heart Failure

11 Minutes

Edited & medically reviewed by THE BALANCE Team

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CONTENTS

Studies have linked cocaine use to a huge increase in the risk of heart failure, and even occasional use has been linked to an up to 24 percent increase in the risk of cardiac complications [1]. The powerful effect of the stimulant on the cardiovascular system includes coronary artery vasoconstriction, cardiac arrhythmias and myocardial ischemia all contributing to the etiology of heart failure.

The risks of cocaine-induced heart failure are further magnified by the fact that about 70% of cocaine users also have preexisting cardiovascular disease, a finding which underscores the need for targeted interventions to address this increasingly important public health issue [2].

Most illicit drugs can have bad effects on your heart and vessels, extending from a fast or slow heart rate to a full-fledged myocardial infarction (heart attack). Infusing illicit drugs to your blood can also lead to serious cardiovascular problems, including bacterial infections of heart valves and vessels and collapsed veins.

Most drugs like cocaine, heroin, and amphetamine, affect the nervous system in many ways and can alter the level of consciousness of the user. Apart from high potential for addiction, the risks and side effects for your heart include:

Significant alteration in body metabolism and appearance of signs changes in heart rate, body temperature, and blood pressure
The likelihood of additional ingredients, like poisons, talc, herbicides, or other particles, with a high possibility of a lethal reaction
Arrhythmias (abnormality of heart beat rhythm), raised blood pressure, peripheral artery disease, cardiomyopathy (dysfunction of heart muscles), arterial plaque formation (causing narrowing of arteries), and increased blood clotting.
Heart compromise, myocardial ischemia (damage to heart muscles), stroke and other acute coronary consequences.
Greater risk of death in those with prior history of heart disease,

Cocaine is one of the most frequently used illicit leisure drugs globally. Since even seasonal use of cocaine may be related with short-term or long-term heart toxicity, the great numbers of compromised individuals may present to clinics with the side effects related to the heart and vascular system. Hence, the medical history should also include queries regarding cocaine use, particularly concentrating on signs linked with ischemic heart disease like heart attack.

Cocaine abuse is more commonly related with short-term rather than long-term cardiovascular illness. Between cocaine users who come to emergency departments, complaints related to heart, specifically chest pain, are common [1,2]. In these patients, acute coronary syndromes conditions (including myocardial infarction and ischemia), aortic rupture or dissection, myocarditis, arrhythmias, and vasculitis need to be evaluated [3].

There is a lot of medical evidence for how cocaine causes heart failure; it is not anecdotal. The powerful stimulant properties of the drug place great strain on the cardiovascular system and can lead to both acute and chronic heart problems. The studies show that cocaine users are at a much higher risk of developing heart conditions than non-users.

Why Is Cocaine Bad For Your Heart

Cocaine is harmful to the heart because its molecule constricts blood vessels and raises both the heart rate and the blood pressure. Its constriction lowers the supply of blood to necessary organs including the heart itself. If the heart muscle doesn’t get enough blood over time, it becomes damaged, scarred and weaker.

In addition, cocaine raises the likelihood of blood clot formation, which can close off coronary arteries and cause a heart attack. That’s why cocaine use is one of the major causes of myocardial infarction (heart attack) in people under 50.

The Mechanism Of Action Of Cocaine: A Brief Look

At the cellular level, cocaine has significant effects on the heart channels. It keeps the neurotransmitters like norepinephrine, dopamine, and serotonin from being taken back up in the synapse (the synaptic cleft) where they are released by the presynaptic cell – these neurotransmitters accumulate in the synapse instead. It results in intense stimulation of the central nervous system, and the cardiovascular system.

The blood pressure goes up and the heart works harder over time. Repeatedly over time, these effects wear down the heart muscle leading to hypertrophy (thickening of the heart wall) and eventually heart failure.

Cocaine And The Nervous System

Cocaine’s effects on the cardiovascular system are in part due to its action on the nervous system. Cocaine excites the sympathetic nervous system, causing a “fight or flight” reaction when none is necessary. An elevated heart rate and constricted blood vessels are part of this response and can tax the heart and cause problems.

Also, cocaine’s effects on the brain can affect a person’s judgment and can lead to more cocaine use or mix it with other substances. Such behaviors further increase the risk of cardiovascular events, such as a cocaine induced heart attack.

Cocaine use is not a personal health problem but it impacts an individual’s physical health, mental wellbeing and socioeconomic status. The effects of cocaine use — especially on the heart — often spread out in other ways.

Physical And Mental Health Problems

Cocaine’s effects on the cardiovascular system are physically severe, but they don’t happen in isolation. The long-term users usually have a wide spread systemic health complication such as weakened body immunity, chronic respiratory problems, and gastrointestinal complications. These problems often make it harder for someone to recover from heart failure.

Simply put, because there are psychological changes that occur due to cocaine as a result of cocaine addiction, one can develop mental health diseases like depression, anxiety and paranoia. Not only does the stress of managing these issues take its toll on the heart but the physiological toll itself causes a cycle of declining health that can be hard to break. Cocaine use is constantly stimulating, and then crashing, causing exhaustion and emotional instability, which is especially dangerous when combined with existing cardiovascular problems.

Socioeconomic Impact: Financial And Social Challenges

One other important complication is the financial burden of cocaine addiction. The cost of supporting a cocaine habit can be very high, leaving the user in debt, unemployed or feuding with their friends and family. These stresses can worsen heart disease, and they affect the individual and create stressors that affect both the individual and the individual’s socioeconomic pressures.

Additionally, drug use and addiction are a highly stigmatized condition which makes people who are hesitant about calling their doctor to ask about opioid withdrawal symptoms. Cocaine induced heart problems can progress rapidly and untreated can lead to fatal outcomes. In addition, in some cases, where there are socioeconomic challenges the healthcare access suffices to compound the risks.

Cocaine use has combined physical, mental and socioeconomic impacts which indicate the need to approach addiction in a whole person manner. Recognizing the bigger picture of the health issues associated with cocaine help us to support better and to reduce the stigma of addiction.

The various heart complications associated with Cocaine include:

Chest Pain

Chest pain is a common cardiac complaint in cocaine users because of the long-term health complications of the drug.

The many causes of chest pain associated with cocaine use include changes in the body’s demand for oxygens of arteries around the heart, heart attack, heart rhythm abnormalities, and heart infections.

Higher Blood Pressure

Cocaine use can increase the risk of heart health problems by elevating blood pressure.

A study conducted in 2014 indicates that the risk of high blood pressure may exist even in healthy and younger people and in those who only occasionally use cocaine [4].

Heart Arrhythmias

Elevated heart rate and irregular heart rhythm are more common in people who abuse cocaine. One of the common reasons is the electrolyte imbalance that is associated with cocaine use. The common electrolytes involved include Sodium and potassium.

These electrolytes play a vital role in maintaining the normal electrical activity of the heart. It can cause defects in the heart rhythm and a raised heart rate.

Damage To The Structure Of The Heart

Cocaine may destroy the physical architecture of the heart either directly or indirectly. the direct insult includes direct damage to the heart muscles whereas the indirect measures include raised blood pressure and changes in the coronary arteries.

A medium-scale study conducted in 2014 concluded that left ventricle enlargement was more common in otherwise young and healthy individuals who used Cocaine compared to non-users [4]. The study also found an increased risk of stiffness in blood vessels particularly the aorta, a vital and largest artery in the body.

Coronary Artery Disease

There is mixed evidence that suggests that regular use of cocaine may raise the risk of coronary artery disease. This is a disease of the blood vessels of the heart causing narrowing of the blood vessels due to the development of plaque in the arteries. Coronary artery disease is a well-known risk factor for sudden death due to stroke and heart attack.

Cocaine users can have other risk factors like eating unhealthy food or being overweight or the long-term use of cocaine may further damage the heart. This additional damage may increase the chances of a full-fledged heart attack. Cocaine is notorious for inducing the spasms of coronary arteries which further reduces the blood flow to the heart, causing extra damage.

Congestive Heart Failure

A chronic medical complication of cocaine is congestive heart failure which means the heart muscles are so damaged that the heart cannot pump the blood effectively. With time the inefficient pumping of the heart can lead to multi-system organ failure.

Heart Attack And Stroke

As mentioned previously, the risk of stroke in heart attack increases with damage to the heart muscles and blood vessels. Coronary artery disease higher blood pressure, and other rest factors increase the chances of stroke in heart attack.

The blocking of sodium and potassium channels in the heart caused by cocaine affects the rhythm of the heart which can lead to embolism. Through this mechanism, thrombi (clotted blood) can be lodged in small arteries of the heart and brain, further restricting the blood flow and leading to heart muscle and brain damage.

A study published in 2018 found that the otherwise low-risk population of healthy and young people may have an increased risk of heart failure due to cocaine use [4]. This study examined 2097 people below 50 years of age who had a history of myocardial infarction.

For individuals with heart problems following a history of long-term cocaine use the right strategy to confirm the particular diagnosis varies:

Acute myocardial ischemia/infarction – Typical symptoms, changes in ECG, loss of myocardium on imaging studies, and recent rise in heart biomarkers are indicators of acute ischemia.

Aortic dissection: Confirmation of dissection of the aorta requires imaging of the heart that can demonstrate the dissection flaps separating the true lumen from the false lumen.

Муοсаrditis: Rise in specific heart biomarkers (such as Pro-BNP, troponin, CKMB), ECG changes cardiac dysfunction on 2D echocardiogram and abnormalities of heart rhythm specifically in a clinical setting where these changes cannot be otherwise explained.

Саrԁiοmуоpаthу: Reduced ventricular function and myocardial contractility as seen on heart imaging.

Arrhуthmiаs: Symptoms (palpitations, syncope). The diagnosis is confirmed by continuous ΕСG monitoring or 12-lead ECG.

Ѕtrοkе: In-person physical examination findings and typical symptoms are usually confirmatory along with imaging studies such as MRI or CT Scan Brain.

Furthermore, a history of recent Cοсaine use can be confirmed by urine testing for Cοсaine and its metabolites. Contaminants in cocaine may contribute to the heart problems observed in Cοcаine users. Different adulterants are usually mixed with illicit Cοϲаine supplies [5], some of which may have marked cardiovascular toxicities. For instance, levamisole, a drug used for the eradication of worms, has been reported to induce the euphoric effects of Cοсainе and is a commonly identified contaminant linked with acute coronary syndrome [6].

Addiction is a critical step to preventing more heart damage and improving overall health. First of all, let’s acknowledge the fact that there’s a problem, then let’s seek help. Here are some options for tackling cocaine addiction:

Detoxification and Medical Care: Detox programs are supervised and essentially the individual can safely experience the withdrawal symptoms and reduce the risk of relapse. The programs are particularly helpful for people who are already suffering from cocaine-related health problems.

Therapy and Counseling: Cognitive behavior modification (CBT) and other counseling methodologies including the buildling of coping strategies can be used to cover psychological aspects, including behavioral difficulties.

Support Groups: Narcotics Anonymous (NA) is one of many groups that offer a sense of community and common experiences that are so important in maintaining long term sobriety.

Medication-Assisted Treatment (MAT): There are no specific medications that have been approved to treat cocaine addiction, but a few drugs may help control cravings and other health problems related to the drug, such as heart problems.

Comprehensive Cardiac Care: People who have heart damage should likewise be working with a cardiologist in terms of following their cardiovascular health.

By tackling both the physical and psychological part of cocaine usage, people can make an effort for them to be recovered and quite reduce their threat of developing future problems, such as heart failure.

1. Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int J Mol Sci. 2019 Jan 29;20(3):584. doi: 10.3390/ijms20030584. PMID: 30700023; PMCID: PMC6387265.

2. Pergolizzi JV Jr, Magnusson P, LeQuang JAK, Breve F, Varrassi G. Cocaine and Cardiotoxicity: A Literature Review. Cureus. 2021 Apr 20;13(4):e14594. doi: 10.7759/cureus.14594. PMID: 34036012; PMCID: PMC8136464.

3. Kozor R, Grieve SM, Buchholz S, Kaye S, Darke S, Bhindi R, et al. (2014) Regular Cocaine Use Is Associated with Increased Systolic Blood Pressure, Aortic Stiffness and Left Ventricular Mass in Young Otherwise Healthy Individuals. PLoS ONE 9(4): e89710. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089710

4. Cocaine and Marijuana Use Among Young Adults With Myocardial Infarction. J Am Coll Cardiol 2018;71:2540-2551.

5. Solimini R, Rotolo MC, Pellegrini M, Minutillo A, Pacifici R, Busardò FP, Zaami S. Adulteration Practices of Psychoactive Illicit Drugs: An Updated Review. Curr Pharm Biotechnol. 2017;18(7):524-530. doi: 10.2174/1389201018666170710184531. PMID: 28699480.

6. Michaud K, Grabherr S, Shiferaw K, Doenz F, Augsburger M, Mangin P. Acute coronary syndrome after levamisole-adultered cocaine abuse. J Forensic Leg Med. 2014 Jan;21:48-52. doi: 10.1016/j.jflm.2013.10.015. Epub 2013 Nov 5. PMID: 24365689.

FAQs

Is Cocaine-Induced Heart Failure Reversible?

In certain cases, cocaine-induced heart failure may be reversible if the person stops using cocaine and gets medical help right away. The reversibility of heart failure, however, depends on the severity and duration of cocaine use and the presence of underlying heart disease.

Does Cocaine Use Raise The Risk Of Heart Failure In People With Pre-Existing Hypertension?

In people with pre-existing hypertension, yes, cocaine use can increase the risk of heart failure even more. Cocaine can raise blood pressure, more work for the heart, and may trigger heart failure.

Does Cocaine Use During Pregnancy Raise The Risk Of Heart Failure In The Mother And Fetus?

Cocaine use during pregnancy can definitely increase the risk of heart failure in the mother and fetus. Placental insufficiency, fetal growth restriction and premature birth, all of which can increase the risk of heart failure in the fetus, can be caused by cocaine. Moreover, maternal heart failure may also occur when cocaine is used during pregnancy because of an increased cardiac workload and blood pressure.

How Does Cocaine Use Alter The Heart’s Ability To Respond To Stress And Physical Activity?

Use of cocaine may decrease the heart’s reserve capacity and increase risk of cardiac arrhythmias, so its use impairs the heart’s ability to respond to stress and physical activity. It can make the heart less able to adjust to physical demands like exercise or stress, and raise the chance of heart failure.

Is Cocaine-Induced Heart Failure Reversible With Medication And Lifestyle Changes?

Cocaine-induced heart failure can be treated with medication and lifestyle changes including beta blockers, ACE inhibitors, diuretics to lower blood pressure, heart rate and cardiac workload. You can also manage heart failure and reduce the risk of further cardiac damage by also quitting cocaine, exercising regularly, and eating a healthy diet.

HOW THE BALANCE CAN HELP WITH Cocaine

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