Emergency Radiology

, Volume 16, Issue 1, pp 11–19 | Cite as

Cardiovascular complications of cocaine: Imaging findings

  • Carlos S. RestrepoEmail author
  • Carlos A. Rojas
  • Santiago Martinez
  • Roy Riascos
  • Alejandro Marmol-Velez
  • Jorge Carrillo
  • Daniel Vargas
Review Article


Cocaine is the second most commonly abused illicit drug in the US and the most common one involved in emergency department visits, the majority of which are related to the cardiovascular system. Cardiovascular complications related with cocaine abuse include myocardial ischemia and infarction, myocarditis, hypertrophic cardiomyopathy, dilated cardiomyopathy, aortic dissection, thrombosis, stroke and cerebral hemorrhage, and different forms of visceral ischemia, among others. In an era where cocaine use has reached epidemic proportions, it is necessary for the radiologist to understand the pathophysiology, clinical presentation, and imaging characteristics of its cardiovascular complications.


Cocaine Cardiovascular system Myocardial infarction Cardiomyopathy Myocarditis Stroke Aortic dissection Visceral ischemia Renal infarction 


  1. 1.
    Services UDoHaH. Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings, 2006Google Scholar
  2. 2.
    Restrepo CS, Carrillo JA, Martinez S et al (2007) Pulmonary complications from cocaine and cocaine-based substances: imaging manifestations. Radiographics 27:941–956. doi: 10.1148/rg.274065144 PubMedCrossRefGoogle Scholar
  3. 3.
    Services UDoHaH. Monitoring the Future. Substance Abuse and Mental Health Services Administration, Results from the 2005 National Survey on Drug Use and Health: National Findings. 2006Google Scholar
  4. 4.
    Brody SL, Slovis CM, Wrenn KD (1990) Cocaine-related medical problems: consecutive series of 233 patients. Am J Med 88:325–331. doi: 10.1016/0002-9343(90)90484-U PubMedCrossRefGoogle Scholar
  5. 5.
    Shannon M (1988) Clinical toxicity of cocaine adulterants. Ann Emerg Med 17:1243–1247. doi: 10.1016/S0196-0644(88)80078-7 PubMedCrossRefGoogle Scholar
  6. 6.
    Kloner RA, Hale S, Alker K et al (1992) The effects of acute and chronic cocaine use on the heart. Circulation 85:407–419PubMedGoogle Scholar
  7. 7.
    Billman GE (1990) Mechanisms responsible for the cardiotoxic effects of cocaine. FASEB J 4:2469–2475PubMedGoogle Scholar
  8. 8.
    Frishman WH, Del Vecchio A, Sanal S et al (2003) Cardiovascular manifestations of substance abuse part 1: cocaine. Heart Dis 5:187–201. doi: 10.1097/01.hdx.0000074519.43281.fa PubMedCrossRefGoogle Scholar
  9. 9.
    Gotway MB, Marder SR, Hanks DK et al (2002) Thoracic complications of illicit drug use: an organ system approach. Radiographics 22(Spec No):S119–S135PubMedGoogle Scholar
  10. 10.
    Hagan IG, Burney K (2007) Radiology of recreational drug abuse. Radiographics 27:919–940. doi: 10.1148/rg.274065103 PubMedCrossRefGoogle Scholar
  11. 11.
    Lange RA, Hillis LD (2001) Cardiovascular complications of cocaine use. N Engl J Med 345:351–358. doi: 10.1056/NEJM200108023450507 PubMedCrossRefGoogle Scholar
  12. 12.
    Rump AF, Theisohn M, Klaus W (1995) The pathophysiology of cocaine cardiotoxicity. Forensic Sci Int 71:103–115. doi: 10.1016/0379-0738(94)01638-L PubMedCrossRefGoogle Scholar
  13. 13.
    Billman GE (1994) The effect of adrenergic receptor antagonists on cocaine-induced ventricular fibrillation: alpha but not beta adrenergic receptor antagonists prevent malignant arrhythmias independent of heart rate. J Pharmacol Exp Ther 269:409–416PubMedGoogle Scholar
  14. 14.
    Billman GE (1995) Cocaine: a review of its toxic actions on cardiac function. Crit Rev Toxicol 25:113–132. doi: 10.3109/10408449509021610 PubMedCrossRefGoogle Scholar
  15. 15.
    Mo W, Singh AK, Arruda JA et al (1998) Role of nitric oxide in cocaine-induced acute hypertension. Am J Hypertens 11:708–714. doi: 10.1016/S0895-7061(98)00041-7 PubMedCrossRefGoogle Scholar
  16. 16.
    Wilbert-Lampen U, Seliger C, Zilker T et al (1998) Cocaine increases the endothelial release of immunoreactive endothelin and its concentrations in human plasma and urine: reversal by coincubation with sigma-receptor antagonists. Circulation 98:385–390PubMedGoogle Scholar
  17. 17.
    Perera R, Kraebber A, Schwartz MJ (1997) Prolonged QT interval and cocaine use. J Electrocardiol 30:337–339. doi: 10.1016/S0022-0736(97)80047-7 PubMedCrossRefGoogle Scholar
  18. 18.
    Perreault CL, Morgan KG, Morgan JP (1991) Effects of cocaine on intracellular calcium handling in cardiac and vascular smooth muscle. NIDA Res Monogr 108:139–153PubMedGoogle Scholar
  19. 19.
    Billman GE, Hoskins RS (1988) Cocaine-induced ventricular fibrillation: protection afforded by the calcium antagonist verapamil. FASEB J 2:2990–2995PubMedGoogle Scholar
  20. 20.
    Boghdadi MS, Henning RJ (1997) Cocaine: pathophysiology and clinical toxicology. Heart Lung 26:466–483. Quiz 484–485. doi: 10.1016/S0147-9563(97)90040-6 PubMedCrossRefGoogle Scholar
  21. 21.
    Webber J, Kline RA, Lucas CE (1999) Aortic thrombosis associated with cocaine use: report of two cases. Ann Vasc Surg 13:302–304. doi: 10.1007/s100169900261 PubMedCrossRefGoogle Scholar
  22. 22.
    Mirzayan R, Hanks SE, Weaver FA (1998) Cocaine-induced thrombosis of common iliac and popliteal arteries. Ann Vasc Surg 12:476–481. doi: 10.1007/s100169900188 PubMedCrossRefGoogle Scholar
  23. 23.
    Qureshi AI, Suri MF, Guterman LR et al (2001) Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey. Circulation 103:502–506PubMedGoogle Scholar
  24. 24.
    Moliterno DJ, Willard JE, Lange RA et al (1994) Coronary-artery vasoconstriction induced by cocaine, cigarette smoking, or both. N Engl J Med 330:454–459. doi: 10.1056/NEJM199402173300702 PubMedCrossRefGoogle Scholar
  25. 25.
    Randall T (1992) Cocaine, alcohol mix in body to form even longer lasting, more lethal drug. JAMA 267:1043–1044. doi: 10.1001/jama.267.8.1043 PubMedCrossRefGoogle Scholar
  26. 26.
    Hearn WL, Rose S, Wagner J et al (1991) Cocaethylene is more potent than cocaine in mediating lethality. Pharmacol Biochem Behav 39:531–533. doi: 10.1016/0091-3057(91)90222-N PubMedCrossRefGoogle Scholar
  27. 27.
    Gitter MJ, Goldsmith SR, Dunbar DN et al (1991) Cocaine and chest pain: clinical features and outcome of patients hospitalized to rule out myocardial infarction. Ann Intern Med 115:277–282PubMedGoogle Scholar
  28. 28.
    Hollander JE, Hoffman RS, Gennis P et al (1994) Prospective multicenter evaluation of cocaine-associated chest pain. Cocaine Associated Chest Pain (COCHPA) Study Group. Acad Emerg Med 1:330–339PubMedGoogle Scholar
  29. 29.
    Chakko S, Fernandez A, Mellman TA et al (1992) Cardiac manifestations of cocaine abuse: a cross-sectional study of asymptomatic men with a history of long-term abuse of “crack” cocaine. J Am Coll Cardiol 20:1168–1174PubMedGoogle Scholar
  30. 30.
    Hollander JE, Vignona L, Burstein J (1997) Predictors of underlying coronary artery disease in cocaine associated myocardial infarction: a meta-analysis of case reports. Vet Hum Toxicol 39:276–280PubMedGoogle Scholar
  31. 31.
    Minor RL Jr, Scott BD, Brown DD et al (1991) Cocaine-induced myocardial infarction in patients with normal coronary arteries. Ann Intern Med 115:797–806PubMedGoogle Scholar
  32. 32.
    Kolodgie FD, Virmani R, Cornhill JF et al (1991) Increase in atherosclerosis and adventitial mast cells in cocaine abusers: an alternative mechanism of cocaine-associated coronary vasospasm and thrombosis. J Am Coll Cardiol 17:1553–1560PubMedGoogle Scholar
  33. 33.
    Satran A, Bart BA, Henry CR et al (2005) Increased prevalence of coronary artery aneurysms among cocaine users. Circulation 111:2424–2429. doi: 10.1161/01.CIR.0000165121.50527.DE PubMedCrossRefGoogle Scholar
  34. 34.
    Wiener RS, Lockhart JT, Schwartz RG (1986) Dilated cardiomyopathy and cocaine abuse. Report of two cases. Am J Med 81:699–701. doi: 10.1016/0002-9343(86)90559-0 PubMedCrossRefGoogle Scholar
  35. 35.
    Willens HJ, Chakko SC, Kessler KM (1994) Cardiovascular manifestations of cocaine abuse. A case of recurrent dilated cardiomyopathy. Chest 106:594–600. doi: 10.1378/chest.106.2.594 PubMedCrossRefGoogle Scholar
  36. 36.
    Afonso L, Mohammad T, Thatai D (2007) Crack whips the heart: a review of the cardiovascular toxicity of cocaine. Am J Cardiol 100:1040–1043. doi: 10.1016/j.amjcard.2007.04.049 PubMedCrossRefGoogle Scholar
  37. 37.
    Arora S, Alfayoumi F, Srinivasan V (2006) Transient left ventricular apical ballooning after cocaine use: is catecholamine cardiotoxicity the pathologic link. Mayo Clin Proc 81:829–832PubMedCrossRefGoogle Scholar
  38. 38.
    Tazelaar HD, Karch SB, Stephens BG et al (1987) Cocaine and the heart. Hum Pathol 18:195–199. doi: 10.1016/S0046-8177(87)80338-6 PubMedCrossRefGoogle Scholar
  39. 39.
    Ren S, Tong W, Lai H et al (2006) Effect of long-term cocaine use on regional left ventricular function as determined by magnetic resonance imaging. Am J Cardiol 97:1085–1088. doi: 10.1016/j.amjcard.2005.10.056 PubMedCrossRefGoogle Scholar
  40. 40.
    Brickner ME, Willard JE, Eichhorn EJ et al (1991) Left ventricular hypertrophy associated with chronic cocaine abuse. Circulation 84:1130–1135PubMedGoogle Scholar
  41. 41.
    Corral Ansa L, Manuel Galvan J, Ferrer Sierra MJ (2001) Balloon counterpulsation in cocaine induced cardiomyopathy. Med Clin (Barc) 116:559Google Scholar
  42. 42.
    Duell PB (1987) Chronic cocaine abuse and dilated cardiomyopathy. Am J Med 83:601. doi: 10.1016/0002-9343(87)90784-4 PubMedCrossRefGoogle Scholar
  43. 43.
    Billman GE, Lappi MD (1993) Effects of cocaine on cardiac vagal tone before and during coronary artery occlusion: cocaine exacerbates the autonomic response to myocardial ischemia. J Cardiovasc Pharmacol 22:869–876PubMedCrossRefGoogle Scholar
  44. 44.
    McCrohon JA, Moon JC, Prasad SK et al (2003) Differentiation of heart failure related to dilated cardiomyopathy and coronary artery disease using gadolinium-enhanced cardiovascular magnetic resonance. Circulation 108:54–59. doi: 10.1161/01.CIR.0000078641.19365.4C PubMedCrossRefGoogle Scholar
  45. 45.
    Vogel-Claussen J, Rochitte CE, Wu KC et al (2006) Delayed enhancement MR imaging: utility in myocardial assessment. Radiographics 26:795–810. doi: 10.1148/rg.263055047 PubMedCrossRefGoogle Scholar
  46. 46.
    Chambers HF, Morris DL, Tauber MG et al (1987) Cocaine use and the risk for endocarditis in intravenous drug users. Ann Intern Med 106:833–836PubMedGoogle Scholar
  47. 47.
    Virmani R, Robinowitz M, Smialek JE et al (1988) Cardiovascular effects of cocaine: an autopsy study of 40 patients. Am Heart J 115:1068–1076. doi: 10.1016/0002-8703(88)90078-6 PubMedCrossRefGoogle Scholar
  48. 48.
    Hsue PY, Salinas CL, Bolger AF et al (2002) Acute aortic dissection related to crack cocaine. Circulation 105:1592–1595. doi: 10.1161/01.CIR.0000012524.44897.3A PubMedCrossRefGoogle Scholar
  49. 49.
    Eagle KA, Isselbacher EM, DeSanctis RW (2002) Cocaine-related aortic dissection in perspective. Circulation 105:1529–1530PubMedGoogle Scholar
  50. 50.
    Singh S, Trivedi A, Adhikari T et al (2007) Cocaine-related acute aortic dissection: patient demographics and clinical outcomes. Can J Cardiol 23:1131–1134PubMedGoogle Scholar
  51. 51.
    Rashid J, Eisenberg MJ, Topol EJ (1996) Cocaine-induced aortic dissection. Am Heart J 132:1301–1304. doi: 10.1016/S0002-8703(96)90486-X PubMedCrossRefGoogle Scholar
  52. 52.
    Neri E, Toscano T, Massetti M et al (2001) Cocaine-induced intramural hematoma of the ascending aorta. Tex Heart Inst J 28:218–219PubMedGoogle Scholar
  53. 53.
    Treadwell SD, Robinson TG (2007) Cocaine use and stroke. Postgrad Med J 83:389–394. doi: 10.1136/pgmj.2006.055970 PubMedCrossRefGoogle Scholar
  54. 54.
    Zandio B, Erro M, Cabada T et al (2008) Cocaine-induced brain stem stroke associated to cranial midline destructive lesions. Neurologia 23:55–58Google Scholar
  55. 55.
    Wallace EA, Wisniewski G, Zubal G et al (1996) Acute cocaine effects on absolute cerebral blood flow. Psychopharmacology (Berl) 128:17–20. doi: 10.1007/s002130050104 CrossRefGoogle Scholar
  56. 56.
    Boco T, Macdonald RL (2004) Absence of acute cerebral vasoconstriction after cocaine-associated subarachnoid hemorrhage. Neurocrit Care 1:449–454. doi: 10.1385/NCC:1:4:449 PubMedCrossRefGoogle Scholar
  57. 57.
    Levine SR, Brust JC, Futrell N et al (1991) A comparative study of the cerebrovascular complications of cocaine: alkaloidal versus hydrochloride—a review. Neurology 41:1173–1177PubMedGoogle Scholar
  58. 58.
    Levine SR, Brust JC, Futrell N et al (1990) Cerebrovascular complications of the use of the “crack” form of alkaloidal cocaine. N Engl J Med 323:699–704PubMedGoogle Scholar
  59. 59.
    Brown E, Prager J, Lee HY et al (1992) CNS complications of cocaine abuse: prevalence, pathophysiology, and neuroradiology. AJR Am J Roentgenol 159:137–147PubMedGoogle Scholar
  60. 60.
    Rojas R, Riascos R, Vargas D et al (2005) Neuroimaging in drug and substance abuse part I: cocaine, cannabis, and ecstasy. Top Magn Reson Imaging 16:231–238. doi: 10.1097/01.rmr.0000192156.46492.24 PubMedCrossRefGoogle Scholar
  61. 61.
    Peterson PL, Roszler M, Jacobs I et al (1991) Neurovascular complications of cocaine abuse. J Neuropsychiatry Clin Neurosci 3:143–149PubMedGoogle Scholar
  62. 62.
    Strickland TL, Mena I, Villanueva-Meyer J et al (1993) Cerebral perfusion and neuropsychological consequences of chronic cocaine use. J Neuropsychiatry Clin Neurosci 5:419–427PubMedGoogle Scholar
  63. 63.
    Ellis CN, McAlexander WW (2005) Enterocolitis associated with cocaine use. Dis Colon Rectum 48:2313–2316. doi: 10.1007/s10350-005-0195-5 PubMedCrossRefGoogle Scholar
  64. 64.
    Niazi M, Kondru A, Levy J et al (1997) Spectrum of ischemic colitis in cocaine users. Dig Dis Sci 42:1537–1541. doi: 10.1023/A:1018839415743 PubMedCrossRefGoogle Scholar
  65. 65.
    Osorio J, Farreras N, Ortiz De Zarate L et al (2000) Cocaine-induced mesenteric ischaemia. Dig Surg 17:648–651. doi: 10.1159/000051980 PubMedCrossRefGoogle Scholar
  66. 66.
    Herskowitz MM, Gillego V, Ward M et al (2002) Cocaine-induced mesenteric ischemia: treatment with intra-arterial papaverine. Emerg Radiol 9:172–174PubMedGoogle Scholar
  67. 67.
    Schultz JSB, Sumpio BE, Gusberg RJ (1998) Cocaine-associated myocardial and mesenteric ischemia: a case report and review of the literature. Int J Angiol 7(1):1–5. doi: 10.1007/BF01616266 CrossRefGoogle Scholar
  68. 68.
    Peterson CM, Menias CO, Balfe DM et al (2006) Adult intussusception due to cocaine-induced bowel wall hematoma: a case study. Emerg Radiol 12:177–179. doi: 10.1007/s10140-006-0475-y PubMedCrossRefGoogle Scholar
  69. 69.
    Hazanas FH, Torres CP, Delgado FI (1993) Multiorgan failure (MOF) and intestinal ischemia after cocaine intoxication. Intensive Care Med 19:239–240. doi: 10.1007/BF01694779 PubMedCrossRefGoogle Scholar
  70. 70.
    Bemanian S, Motallebi M, Nosrati SM (2005) Cocaine-induced renal infarction: report of a case and review of the literature. BMC Nephrol 6:10. doi: 10.1186/1471-2369-6-10 PubMedCrossRefGoogle Scholar
  71. 71.
    Delaney K, Hoffman RS (1991) Pulmonary infarction associated with crack cocaine use in a previously healthy 23-year-old woman. Am J Med 91:92–94. doi: 10.1016/0002-9343(91)90080-H PubMedCrossRefGoogle Scholar
  72. 72.
    Dettmeyer R, Schlamann M, Madea B (2004) Cocaine-associated abscesses with lethal sepsis after splenic infarction in a 17-year-old woman. Forensic Sci Int 140:21–23. doi: 10.1016/j.forsciint.2003.11.031 PubMedCrossRefGoogle Scholar
  73. 73.
    Homler HJ (1995) Nontraumatic splenic hematoma related to cocaine abuse. West J Med 163:160–162PubMedGoogle Scholar
  74. 74.
    Marder VJ, Mellinghoff IK (2000) Cocaine and Buerger disease: is there a pathogenetic association. Arch Intern Med 160:2057–2060PubMedGoogle Scholar
  75. 75.
    Downing GJ, Horner SR, Kilbride HW (1991) Characteristics of perinatal cocaine-exposed infants with necrotizing enterocolitis. Am J Dis Child 145:26–27PubMedGoogle Scholar
  76. 76.
    Czyrko C, Del Pin CA, O’Neill JA Jr et al (1991) Maternal cocaine abuse and necrotizing enterocolitis: outcome and survival. J Pediatr Surg 26:414–418. Discussion 419–421.doi: 10.1016/0022-3468(91)90988-6 PubMedCrossRefGoogle Scholar
  77. 77.
    Yap TE, Diana D, Herson V et al (1994) Fetal myocardial calcification associated with maternal cocaine use. Am J Perinatol 11:179–183PubMedCrossRefGoogle Scholar
  78. 78.
    Townsend RR, Laing FC, Jeffrey RB Jr (1988) Placental abruption associated with cocaine abuse. AJR Am J Roentgenol 150:1339–1340PubMedGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2008

Authors and Affiliations

  • Carlos S. Restrepo
    • 1
    • 7
    Email author
  • Carlos A. Rojas
    • 2
  • Santiago Martinez
    • 3
  • Roy Riascos
    • 4
  • Alejandro Marmol-Velez
    • 5
  • Jorge Carrillo
    • 6
  • Daniel Vargas
    • 1
  1. 1.RadiologyThe University of Texas HSC at San AntonioSan AntonioUSA
  2. 2.RadiologyUniversity of South FloridaTampaUSA
  3. 3.RadiologyDuke UniversityDurhamUSA
  4. 4.RadiologyUniversity of Texas Medical BranchGalvestonUSA
  5. 5.CardiologyThe University of Texas HSC at San AntonioSan AntonioUSA
  6. 6.RadiologyUniversidad Nacional de ColombiaBogotaColombia
  7. 7.Thoracic RadiologyThe University of Texas Health Science Center at San AntonioSan AntonioUSA

Personalised recommendations