SynopsisCodesDifferential Diagnosis & PitfallsBest TestsDrug Reaction DataReferences
Cocaine-related cardiomyopathy
Other Resources UpToDate PubMed

Cocaine-related cardiomyopathy

Contributors: Christine Osborne MD, Ryan Hoefen MD, PhD
Other Resources UpToDate PubMed


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


I42.7 – Cardiomyopathy due to drug and external agent

72972005 – Dilated cardiomyopathy secondary to drug

Differential Diagnosis & Pitfalls

  • Acute coronary syndrome
  • Pericarditis
  • Myocarditis
  • Hyperthyroidism
  • Dilated cardiomyopathy
  • Hypertrophic cardiomyopathy

Best Tests

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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Last Updated:03/29/2017
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Cocaine-related cardiomyopathy
A medical illustration showing key findings of Cocaine-related cardiomyopathy : Chest pain, Dyspnea, HR increased, BP increased
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