The full content of Annals is available to subscribers

Subscribe/Learn More  >
Articles |

Recurrent Coronary Vasoconstriction Caused by Intranasal Cocaine: Possible Role for Metabolites

Walter C. Brogan III, MD, PhD; Richard A. Lange, MD; D. Brent Glamann, MD; and L. David Hillis, MD
[+] Article, Author, and Disclosure Information

Requests for Reprints: L. David Hillis, MD, Room CS 7.102, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9047.

Current Author Addresses: Drs. Brogan, Lange, Glamann, and Hillis: Room 7.102, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75235-9047.

© 1992 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1992;116(7):556-561. doi:10.7326/0003-4819-116-7-556
Text Size: A A A

Objective: To define the temporal characteristics of cocaine-induced coronary vasoconstriction in humans and to assess the relation between cocaine-induced coronary vasoconstriction and the blood concentration of cocaine and its main metabolites.

Design: Randomized, double-blind, controlled clinical trial.

Setting: Cardiac catheterization laboratory of a large teaching hospital.

Patients: Eighteen patients (16 men and 2 women, 37 to 65 years of age) having catheterization for evaluation of chest pain.

Measurements: At catheterization, patients received intranasal saline (8 patients) or cocaine, 2 mg/kg body weight (10 patients). Cineangiographic examination of the left coronary artery and quantitation of the blood concentration of cocaine and its metabolites were done before (baseline) and 30, 60, and 90 minutes after administration of intranasal saline or cocaine.

Results: In response to cocaine, proximal coronary arterial diameter decreased from 2.4 ± 1.6 mm (mean ± SD) at baseline to 2.0 ± 1.4 mm at 30 minutes (P < 0.05). This change corresponded temporally to the peak blood concentration of cocaine. At 60 minutes, the cocaine concentration decreased and coronary artery diameter returned to baseline (2.3 ± 1.6 mm) (P > 0.05 compared with baseline). At 90 minutes, all patients had recurrent vasoconstriction (1.9 ± 1.4 mm, P < 0.05) despite a further decrease in the blood cocaine concentration. This vasoconstriction corresponded temporally with an increasing blood concentration of cocaine's main metabolites, benzoylecgonine and ethyl methyl ecgonine. No changes were observed in the control group.

$ Conclusion: Intranasal cocaine causes recurrent coronary vasoconstriction, which may be due to its metabolites.





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).


Submit a Comment/Letter
Submit a Comment/Letter

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.


Buy Now for $42.00

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Related Articles
Topic Collections
PubMed Articles
Maternal and transplacental effects of cocaine. Ann N Y Acad Sci 1998;846():1-11.
Theodore E. Woodward award: cardiovascular complications of cocaine abuse. Trans Am Clin Climatol Assoc 2004;115():99-111; discussion 112-4.
Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.