Cocaine is a catecholaminergic stimulant that can produce not only chronic cardiomyopathy, but also acute ischemia due to coronary artery vasospasm and tachyarrhythmias. The development of cardiomyopathy is related to microinfarcts from small vessel ischemia. Most patients with cocaine-related cardiomyopathy are in their 30s to 40s, an age pattern that follows cocaine use in the population.

Patients with cocaine-related cardiac disease may present with the sudden onset of heart failure symptoms including dyspnea, orthopnea, volume overload, or symptoms of myocardial ischemia including chest pain, hypertension, and a sense of impending doom.

Physical examination often reveals symptoms of adrenergic excess including tachycardia, hypertension, cerebral vascular accidents, tachyarrhythmias including ventricular tachycardia and ventricular fibrillation, and altered mental status if other drugs were used simultaneously.

Related topic: Cocaine Use Disorder