Cocaine As An Illicit Drug And Heart Diseses Hazard

Like smoking and drinking, using illicit drugs can also
be hazardous to the heart. The problems vary with
the drug used and they range from physiologic to
infectious.

Use of cocaine has snowballed in recent decades, along with the myth that the drug is relatively safe, especially when it is sniffed (“snorted) rather than injected or smoked as “crack.” In fact, no matter how it is used, cocaine can kill. It can disturb the heart's rhythm and cause chest pain, heart attacks, and even sudden death. These effects on the heart can cause death even in the absence of any seizures, the most common of cocaine’s serious noncardiac “side effects.” Dabblers should beware: Even in the absence of underlying heart disease, a single use of only a small amount of the drug has been known to be fatal. Although such deaths are uncommon, they do occur.

Cocaine use is not healthful for anyone, but especially for certain groups. Although the drug has been shown to impair the function of normal hearts, it seems even more likely to cause death in people with any underlying heart disease. And when preg- nant women use cocaine, they not only raise the likelihood of having a miscarriage, a premature delivery, or a low-birth-weight baby, but also of having a baby with a congenital heart abnormality, especially an atrial-septal or ventricular-septal defect.

A variety of mechanisms conspire to cause cocaine’s impairment of the heart. Use of cocaine raises blood pressure, constricts blood vessels, and speeds up heart rate. It may also make blood ceils called platelets more likely to clump and form the blood clots that provoke many heart attacks. In addition, cocaine’s effects on the nervous system disrupt the normal rhythm of the heart, causing arrhythmias (irregular heartbeats). Recently, scientists have established that cocaine binds directly to heart muscle cells, slowing the passage of sodium ions into the cells. Cocaine also causes the release of the neurotransmitter norepinephrine (noradrenaline), a chemical messenger that stimulates the autonomic nervous system. Both changes can lead to arrhythmias.

Heart attacks in young people are rare. However, when they do occur, cocaine is frequently the cause. Friends and even medical personnel may be slow to suspect that a heart attack is taking place because of the victim’s youth; yet the percentage of cocaineinduced heart attacks that are fatal is equal to the percentage of heart attacks from other causes that are fatal. Recurrent chest pain and heart attacks have been reported among those who continue to use cocaine after surviving a cardiac complication.