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 visitshttp://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits

• 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

Some Good News

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 atherosclerosisKollodgie 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 cocaine-

associated 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.