0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Potentiation of Cocaine-Induced Coronary Vasoconstriction by Beta-Adrenergic Blockade

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; and L. David Hillis, MD
[+] Article and Author Information

Grant Support: By ischemic SCOR grant HL 17669 from the National Institutes of Health, Bethesda, Maryland, and a grant from the Texas Affiliate of the American Heart Association, Austin, Texas.

Requests for Reprints: Richard A. Lange, MD, Cardiology Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235.

Current Author Addresses: Drs. Lange, Cigarroa, Flores, McBride, Kim, Wells, Bedotto, Danziger, and Hillis: Cardiology Division, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235.


© 1990 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1990;112(12):897-903. doi:10.7326/0003-4819-112-12-897
Text Size: A A A

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.

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
Topic Collections
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)