PATHOPHYSIOLOGY AND TREATMENT OF COCAINE TOXICITY - IMPLICATIONS FOR THE HEART AND CARDIOVASCULAR-SYSTEM

OBJECTIVE: To review the data on pharmacology, pathophysiology and tre atment of cocaine toxicity, with particular relevance to the heart and cardiovascular system. DATA SOURCE AND STUDY SELECTION: Published epi demiology, laboratory and clinical studies on the pharmacology, electr ophysiology and pathophysiology of cocaine toxicity and its treatment. MAIN RESULTS: Cocaine toxicity-related morbidity and mortality are fr equent due to the potent pharmacological effects of the drug as an ind irect-acting sympathomimetic agent and its class I antiarrhythmic prop erty paradoxically inducing pro-arrhythmia. The cardiac and cardiovasc ular toxic effects of cocaine include various degrees of myocardial is chemia, cardiac arrhythmias, cardiotoxicity, hypertensive effects, cer ebrovascular effects and a hypercoagulable state. Treatment of cocaine toxicity must be based on the multiple factors leading to the toxicit y. Sodium bicarbonate appears to have an important role in the acute s etting with conduction abnormalities, seizures or acidosis. Unopposed alpha-stimulation provided by beta-blockade should be avoided. Central nervous system hyperexcitability should be treated with diazepam. The use of calcium antagonists appears logical. CONCLUSION: Cocaine is an alkaloid with widespread illicit use. The rationale for treating acut e cocaine intoxication has become clearer and more logical with increa sed knowledge of its mechanisms of action.