0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

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 and Author 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
Text Size: A A A

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.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Related Point of Care
Topic Collections
PubMed Articles
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)