Richard A. Lange, MD; Ricardo G. Cigarroa, MD; Eduardo D. Flores, MD; Wade McBride, MD; Anatole S. Kim, MD; Peter J. Wells, MD; John B. Bedotto, MD; Robert S. Danziger, MD; L. David Hillis, MD
Lange RA, Cigarroa RG, Flores ED, McBride W, Kim AS, Wells PJ, et al. Potentiation of Cocaine-Induced Coronary Vasoconstriction by Beta-Adrenergic Blockade. Ann Intern Med. 1990;112:897-903. doi: 10.7326/0003-4819-112-12-897
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Published: Ann Intern Med. 1990;112(12):897-903.
Study Objective: To determine whether beta-adrenergic blockade augments cocaine-induced coronary artery vasoconstriction.
Design: Randomized, double-blind, placebo-controlled trial.
Setting: A cardiac catheterization laboratory in an urban teaching hospital.
Patients: Thirty clinically stable patient volunteers referred for catheterization for evaluation of chest pain.
Interventions: Heart rate, arterial pressure, coronary sinus blood flow (by thermodilution), and epicardial left coronary arterial dimensions were measured before and 15 minutes after intranasal saline or cocaine administration (2 mg/kg body weight) and again after intracoronary propranolol administration (2 mg in 5 minutes).
Measurements and Main Results: No variables changed after saline administration. After cocaine administration, arterial pressure and rate-pressure product increased; coronary sinus blood flow fell (139 ± 28 [mean ± SE] to 120 ± 20 mL/min); coronary vascular resistance (mean arterial pressure divided by coronary sinus blood flow) rose (0.87 ± 0.10 to 1.05 ± 0.10 mm Hg/mL · min); and coronary arterial diameters decreased by between 6% and 9% (P < 0.05 for all variables). Subsequently, intracoronary propranolol administration caused no change in arterial pressure or rate-pressure product but further decreased coronary sinus blood flow (to 100 ± 14 mL/min) and increased coronary vascular resistance (to 1.20 ± 0.12 mm Hg/mL · min) (P < 0.05 for both).
Conclusions: Cocaine-induced coronary vasoconstriction is potentiated by beta-adrenergic blockade. Beta-adrenergic blocking agents probably should be avoided in patients with cocaine-associated myocardial ischemia or infarction.
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Tobacco, Alcohol, and Other Substance Abuse.
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