Toxicity, Cocaine - Last Updated: August 31, 2004
Myocardial infarction and acute coronary syndromes
Patients with cocaine-related MI often have fixed atherosclerotic lesions. While these lesions may themselves be of clinical significance, cocaine-induced elevations in pulse and blood pressure increase myocardial work. The additional metabolic requirements that result may convert an asymptomatic obstruction into one of clinical significance.
Substantial evidence indicates that cocaine use causes accelerated coronary atherosclerosis. According to a 1995 study of trauma fatalities among males with a mean age of 34 years and an incidental finding of cocaine metabolite, 25% had lesions in 2 or more vessels and 19% had disease in 3-4 vessels. Of the control subjects, only 6% had 2-vessel disease and none had 3-vessel or 4-vessel disease. In another study of 22 long-term cocaine users with a mean age of 32 years, all of whom died suddenly with detectable serum cocaine levels, severe narrowing of more than 75% of cross-sectional area was found in 1 or more coronary arteries in 36% of patients.
Hollander and Hoffman review and analyze the literature of 91 patients with cocaine-induced MI. Cardiac catheterization in 54 of the patients demonstrated that 31% had significant coronary atherosclerosis. Autopsy studies of patients with cocaine-related MI revealed atherosclerotic lesions in more than one half of the cases. In another review of medical examiner records, 495 deceased patients were identified with positive toxicologic findings of cocaine; 6 of them, whose mean age was 29 years, had MI with total thrombotic occlusion primarily involving the left anterior descending coronary artery. All of the patients had significant coronary atherosclerosis, with 83% having lesions causing luminal stenosis of more than 75% cross-sectional area in one or more vessels.
Clinton was a big time smoker. I still dont get why people smoke.