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Myocardial Ischemia during Cocaine Withdrawal

Koonlawee Nademanee, MD; David A. Gorelick, MD, PhD; Martin A. Josephson, MD; Michelle A. Ryan, MD; Jeffrey N. Wilkins, MD; Helen A. Robertson, BS; Freny Vaghaiwalla Mody, MD; and Vanida Intarachot, RN
[+] Article, Author, and Disclosure Information

Grant Support: Supported in part by grant R01DA05485-C1 from the National Institutes of Health and grant-in-aid 789G1-3 from the American Heart Association.

Requests for Reprints: Koonlawee Nademanee, MD, West Los Angeles Veterans Administration Medical Center, Cardiology Division 691/W111E, Wilshire and Sawtelle Boulevards, Los Angeles, CA 90073.

Current Author Addresses: Drs. Nademanee, Josephson, Wilkins, Mody, and Ms. Robertson: West Los Angeles Veterans Administration Medical Center. Cardiology 691/W111E, Wilshire and Sawtelle Boulevards, Los Angeles, CA 90073.

Dr. Gorelick: 691/B116 A22-257, West Los Angeles Veterans Administration Medical Center, Wilshire and Sawtelle Boulevards, Los Angeles, CA 90073.

Dr. Ryan: 2865 Atlantic Avenue, Suite 224, Long Beach, CA 90806. Ms. Intarachot: West Los Angeles Veterans Administration Medical Center, Wilshire and Sawtelle Boulevards, Los Angeles, CA 90073.

©1989 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1989;111(11):876-880. doi:10.7326/0003-4819-111-11-876
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Study Objective: To determine the prevalence of myocardial ischemia in patients with cocaine addiction.

Design: Myocardial ischemia in chronic cocaine users was detected by serial 24-hour electrocardiographic ambulatory (Holter) monitoring and exercise treadmill testing in chronic cocaine users. The Holter tapes were coded, scanned in a blinded manner, and mixed with the tapes of 42 normal volunteers and 119 patients with either stable or unstable angina.

Setting: A 28-day inpatient, substance abuse treatment program followed by an outpatient treatment program.

Patients: Twenty-one consecutive male chronic cocaine users.

Main Results: Eight of the 21 patients with cocaine addiction had frequent episodes of ST elevation during Holter monitoring; these episodes occurred almost exclusively during the first 2 weeks of withdrawal. None of the volunteers and patients with stable angina and only 4% of the patients with unstable angina had episodes of ST elevation during Holter monitoring (cocaine users compared with volunteers, P = 0.0004). Of the 20 cocaine patients who had exercise treadmill testing, only 1 had a positive test for ischemia.

Conclusions: Cocaine users frequently develop silent myocardial ischemia manifesting as episodes of ST elevation during the first weeks of withdrawal. The underlying mechanisms for these changes remain unknown, but our observations support the hypothesis that coronary vasospasm plays an important role in cocaine-related ischemic syndromes.





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