Abstract :
Cocaine is used by more than 14 million people worldwide, about 0.3 percent of the global population age is 15
to 64 years. After alcohol, cocaine is the most common cause of acute drug-related emergency department
visits in the United States. Cocaine consumption is more frequently associated with acute cardiovascular
illness. Cocaine stimulates ?1, ?2, B1 and B2 adrenergic receptors through increased levels of norepinephrine and
a lesser extent epinephrine. The cardiovascular effects of cocaine are thought to be similar and regardless to the
route of consumption. An acute coronary syndrome is the most common cardiac problem including myocardial
ischemia and infarction even in young persons without atherosclerosis, aortic dissection and rupture,
arrhythmias, ventricular tachycardia and fibrillation, asystole and finally sudden death. Other cardiovascular
effects that caused by cocaine include coronary artery aneurysm, palpitation, sinus tachycardia, increased
systemic vascular resistance and hypertension crisis, left ventricular hypertrophy, myocarditis, cardiomyopathy,
myocardial fibrosis, bundle branch block, heart block, supraventricular arrhythmia, accelerated atherosclerosis,
hypotension, bradycardia and infective endocarditis among intravenous users.
Cocaine by three mechanisms cause ischemia: 1. increased myocardial oxygen demand, 2. decreased coronary
blood flow due to coronary artery vasoconstriction and spasm and 3. Coronary artery thrombosis via activation
of platelets, stimulation of platelet aggregation and potentiation of thromboxane production
