cocaine – ABC CARDIOL

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Editorial

Heroin by Dreser x Eroica by Beethoven

As a Classical Music lover, I go to the São Paulo Concert Hall frequently. On my way to get there it’s necessary to drive through an area with high density of addicts on streets, known as Crackland. In that moment I get to see closely the important negative social effects and damage of addiction in its users. Now I meet this issue in a different way, reading the paper: “Heroin and Electrocardiography- Effect of Heroin on Electrocardiography parameters” that adds an incremental knowledge in the medical literature about heroin cardiac effects and searches for signals of when this occurs.

The authors of “Heroin and Electrocardiography- Effect of Heroin on Electrocardiography parameters” make it clear that there is little scientific information published in this field. Research in the PubMed shows a 1980 reference called “ECG examinations 115 heroin addicts” with no access to the abstract or the full-text contents. Very little was found about this specific topic since then. How can this be explained considering addiction has since then increased in alarming scale? Is there lack of interest by researchers in this area? Are there little financial resources for researchers? Logistical difficulties for studies in this field? Lack of interest in this social group?

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Case Report

Toxic Dilated Cardiomyopathy: Recognizing a Potentially Reversible Disease

Inês Rangel et al. Marta Amorim Alexandra Gonçalves Carla Sousa … Paulo Bettencourt Maria Júlia Maciel

Introduction

The use of illicit drugs has increased in recent years. Related to this increase, there is a growing need to recognise and properly treat the adverse effects associated with the consumption of these drugs.

These substances can induce several cardiovascular (CV) complications, being this acute or chronic. Some of them are the ischemic and arrhythmic events, the development of dilated cardiomyopathy (DCM) and the left ventricular systolic dysfunction (LVSD).

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Original Article

Characterization of the in vivo cardiac electrophysiologic effects of high-dose cocaine in closed-chest, anesthetized dogs with normal hearts

Guilherme Fenelon et al. Júlio Uchoa José Roberto Otobone Marcos Reis … José Luiz Gomes do Amaral Angelo A. V. De Paola

OBJECTIVE: To characterize the cardiac electrophysiologic effects of cocaine. METHODS: In 8 dogs (9-13 kg), electrophysiologic parameters and programmed stimulation were undertaken using transvenous catheters at baseline, and after cocaine intravenous infusion (12 mg/kg bolus followed by 0.22 mg/kg/min for 25 minutes). RESULTS: Cocaine plasma levels (n=5) rose to 6.73± 0.56 mg/mL. Cocaine did not affect sinus cycle length and arterial pressure. Cocaine prolonged P wave duration (54±6 vs 73±4 ms, P<0.001), PR interval (115±17 vs 164±15 ms, P<0.001), QRS duration (62±10 vs 88±14 ms, P<0.001), and QTc interval (344±28 vs 403±62 ms, P=0.03) but not JT interval (193±35 vs 226±53 ms, NS). Cocaine prolonged PA (9±6 vs 23±8 ms, P<0.001), AH (73±16 vs 92±15 ms; P=0.03), and HV (35±5 vs 45±3ms; P<0.001) intervals and Wenckebach point (247±26 vs 280±28 ms, P=0.04). An increase occurred in atrial (138±8 vs 184± 20 ms; P<0.001) and ventricular (160±15 vs 187±25 ms; P=0.03) refractoriness at a cycle length of 300 ms. Atrial arrhythmias were not induced in any dog. Ventricular fibrillation (VF) was induced in 2/8 dogs at baseline and 4/8 dogs after cocaine. CONCLUSION: High doses of cocaine exert significant class I effects and seem to enhance inducibility of VF but not of atrial arrhythmias.

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Heroin by Dreser x Eroica by Beethoven

Toxic Dilated Cardiomyopathy: Recognizing a Potentially Reversible Disease

Introduction

Characterization of the in vivo cardiac electrophysiologic effects of high-dose cocaine in closed-chest, anesthetized dogs with normal hearts

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