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    Cocaine and coronary artery diseases: a systematic review of the literature.
    J Cardiovasc Med (Hagerstown) 2017 May;18(5):291-294
    aDepartment of Cardiology, Policlinico Casilino bDepartment of Psychiatry, Policlinico Agostino Gemelli, Rome, Italy.
    Cocaine is associated with important cardiac complications such as sudden death, acute myocarditis, dilated cardiomyopathy, life-threatening arrhythmias, and myocardial ischemia as well as infarction. It is well known that cocaine may induce vasospasm through adrenergic stimulation of the coronary arteries. Moreover, cocaine may promote intracoronary thrombosis, triggered by alterations in the plasma constituents, and platelet aggregation, leading to subsequent myocardial infarction. Read More

    The problem of police-related cardiac arrest.
    J Forensic Leg Med 2016 Jul 9;41:36-41. Epub 2016 Apr 9.
    Consultant Pathologist/Toxicologist, P.O. Box 5139, Berkeley, CA, 94705, USA. Electronic address:
    The term "positional asphyxia" was originally used to describe the situation in which the upper airways becomes compromised by sharp angulation of the head or neck, or where the chest wall is splinted and the diaphragm is prevented from moving because of an unusual position of the body. The term was redefined in the early 1980s to describe sudden death during physical restraint of an individual who is in a prone position. A large percent of reported victims were overweight males. Read More

    Sex differences in substance use disorders: focus on side effects.
    Addict Biol 2016 Sep 22;21(5):1030-42. Epub 2016 Mar 22.
    National Laboratory of Gender Medicine of the National Institute of Biostructures and Biosystems, Osilo, Sassari, Italy.
    Although sex differences in several aspects of substance use disorders (SUDs) have been identified, less is known about the importance of possible sex differences in side effects induced by substances of abuse or by medications used to treat SUDs. In the SUD field, the perception of certain subjective effects are actively sought, while all other manifestations might operationally be considered side effects. This article was aimed at reviewing sex differences in side effects induced by alcohol, nicotine, heroin, marijuana and cocaine and by medications approved for alcohol, nicotine and heroin use disorders. Read More

    Prenatal methamphetamine differentially alters myocardial sensitivity to ischemic injury in male and female adult hearts.
    Am J Physiol Heart Circ Physiol 2016 Feb 18;310(4):H516-23. Epub 2015 Dec 18.
    Raabe College of Pharmacy, Ohio Northern University, Ada, Ohio.
    Methamphetamine is one of the most common illicit drugs abused during pregnancy. The neurological effects of prenatal methamphetamine are well known. However, few studies have investigated the potential effects of prenatal methamphetamine on adult cardiovascular function. Read More

    Methamphetamine-Associated Congestive Heart Failure: Increasing Prevalence and Relationship of Clinical Outcomes to Continued Use or Abstinence.
    Cardiovasc Toxicol 2016 Oct;16(4):381-9
    Department of Graduate Medical Education, Scripps Mercy Hospital, 4077 Fifth Avenue, MER-35, San Diego, CA, 92103, USA.
    The purpose of this study was to determine the prevalence of methamphetamine-associated congestive heart failure (MAC) and to evaluate the relationship between methamphetamine abuse and EF and functional status over time. A retrospective review of records from 2009 to 2014 was carried out. Prevalence of methamphetamine abuse among all patients admitted with CHF was calculated for each of the 6 years of the study (n = 141) and was compared with prevalence of cocaine abuse and alcohol abuse. Read More

    Mechanisms of Cardiotoxicity and the Development of Heart Failure.
    Crit Care Nurs Clin North Am 2015 Dec 19;27(4):469-81. Epub 2015 Aug 19.
    School of Nursing and Knight Cardiovascular Institute, Oregon Health and Science University, Mail Code: SN-2N, 3455 SW, US Veterans Hospital Road, Portland, OR 97239-2941, USA. Electronic address:
    Cardiotoxicity is a broad term that refers to the negative effects of toxic substances on the heart. Cancer drugs can cause cardiotoxicity by effects on heart cells, thromboembolic events, and/or hypertension that can lead to heart failure. Rheumatoid arthritis biologics may interfere with ischemic preconditioning and cause/worsen heart failure. Read More

    Drug-induced mitochondrial dysfunction and cardiotoxicity.
    Am J Physiol Heart Circ Physiol 2015 Nov 18;309(9):H1453-67. Epub 2015 Sep 18.
    Laboratory of Cardiovascular Physiology and Tissue Injury, National Institutes of Health/National Institute on Alcohol Abuse and Alcoholism, Bethesda, Maryland;
    Mitochondria has an essential role in myocardial tissue homeostasis; thus deterioration in mitochondrial function eventually leads to cardiomyocyte and endothelial cell death and consequent cardiovascular dysfunction. Several chemical compounds and drugs have been known to directly or indirectly modulate cardiac mitochondrial function, which can account both for the toxicological and pharmacological properties of these substances. In many cases, toxicity problems appear only in the presence of additional cardiovascular disease conditions or develop months/years following the exposure, making the diagnosis difficult. Read More

    Acute myocardial infarction in pregnancy: a statewide analysis.
    J Registry Manag 2015 ;42(1):12-7
    Objective: Acute myocardial infarction (AMI) during pregnancy and the puerperium is a rare but devastating event. The objective of this study was to describe the clinical and epidemiological features of pregnancy-related AMI.

    Methods: A retrospective study was conducted using Texas hospital inpatient data (years 2004-2007). Read More

    Khat use: history and heart failure.
    Oman Med J 2015 Mar;30(2):77-82
    Department of Cardiology, Sana'a University, Sana'a, Yemen.
    Recent reports suggest that 20 million people worldwide are regularly using khat as a stimulant, even though the habit of chewing khat is known to cause serious health issues. Historical evidence suggests khat use has existed since the 13th century in Ethiopia and the southwestern Arabian regions even before the cultivation and use of coffee. In the past three decades, its availability and use spread all over the world including the United States and Europe. Read More

    Oxidative myocardial damage in human cocaine-related cardiomyopathy.
    Eur J Heart Fail 2015 Mar 11;17(3):283-90. Epub 2015 Feb 11.
    Department of Cardiovascular, Respiratory, Nephrologic, Anesthesiologic and Geriatric Sciences, University 'La Sapienza', Viale del Policlinico 155, I-00161, Rome, Italy; Cellular and Molecular Cardiology Lab, IRCCS L. Spallanzani, Rome, Italy.
    Aims: The pathogenesis of cocaine-related cardiomyopathy (CCM) is still unclear. Oxidative damage from cocaine-generated reactive oxygen species (ROS) overcoming myocardial antioxidant reserve has been hypothesized by experimental studies.

    Methods And Results: Ten (2. Read More

    Cardiovascular consequences of cocaine use.
    Trends Cardiovasc Med 2015 Aug 26;25(6):517-26. Epub 2014 Dec 26.
    Department of Cardiology, Marshfield Clinic, Marshfield, WI.
    The cardiovascular consequences of cocaine use are numerous and can be severe, with mechanisms of cardiotoxicity unique to cocaine that include sympathomimetic effects, blockade of sodium and potassium channels, oxidative stress and mitochondrial damage, and disruption of excitation-contraction coupling. In combination, these effects increase myocardial oxygen demand while simultaneously decreasing oxygen supply. Cocaine-associated chest pain is particularly common and, in some instances, associated with a more severe cardiac syndrome, such as myocardial infarction, myocardial ischemia, arrhythmia, cardiomyopathy, aortic dissection, or endocarditis. Read More

    Genetic and toxicologic investigation of Sudden Cardiac Death in a patient with Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC) under cocaine and alcohol effects.
    Int J Legal Med 2015 Jan 16;129(1):89-96. Epub 2014 Nov 16.
    Institute of Public Health, Section of Legal Medicine, Catholic University, Rome, Italy.
    Cocaine and alcohol toxicity is well known, especially when simultaneously abused. These drugs perform both acute and chronic harmfulness, with significant cardiac events such as ventricular arrhythmias, tachycardia, systemic hypertension, acute myocardial infarction, ventricular hypertrophy, and acute coronary syndrome. The present report refers about a patient who died after a documented episode of psychomotor agitation followed by cardiac arrest. Read More

    Stimulant-related Takotsubo cardiomyopathy.
    Am J Emerg Med 2015 Mar 6;33(3):476.e1-3. Epub 2014 Sep 6.
    Highland General Hospital, Oakland, CA.
    Takotsubo cardiomyopathy (TC) is a rare but increasingly recognized mimic of acute coronary syndrome. Patients present with angina,ST-segment changes on electrocardiogram (both elevations and depressions),and rapid rises in cardiac biomarkers. Many kinds of stressful events have been associated with TC, but only a handful of drug-related cases have previously been reported. Read More

    Nonatherosclerotic causes of acute coronary syndrome: recognition and management.
    Curr Cardiol Rep 2014 Nov;16(11):543
    Cardiac Department, Hospital Universitario de La Princesa, Madrid, Spain.
    Acute coronary syndromes (ACS) frequently result from the rupture or erosion of a vulnerable coronary plaque, with associated intracoronary thrombosis. ACS also may occur in patients with angiographically normal coronary arteries. Some of these patients, however, still have angiographically silent underlying coronary artery disease. Read More

    Ergotamine-Induced Takotsubo Cardiomyopathy.
    Am J Ther 2016 Mar-Apr;23(2):e597-600
    1Department of Cardiology, School of Medicine, Dokuz Eylul University, Izmir, Turkey; and 2Department of Cardiology, Medical Park Hospital, School of Medicine, Izmir University, Izmir, Turkey.
    Takotsubo cardiomyopathy (TC) is a recently increasing diagnosed disease showed by transient apical or mid-apical left ventricular dysfunction. It is known as a disease of postmenopausal women, which is usually triggered by emotional or physical stress. Although the trigger is mostly endogenous, some drugs have also been reported as the cause. Read More

    A bailout approach: Transaxillary Impella implantation in toxic cardiomyopathy.
    Asian Cardiovasc Thorac Ann 2014 Jul 3;22(6):722-4. Epub 2013 Oct 3.
    Department of Cardiac Surgery, Montreal Heart Institute and University of Montreal, Montreal, Quebec, Canada
    The femoral artery has been the traditional approach for implantation of the Impella left ventricular assist device. We describe the case of a young man with toxic (cocaine-related) cardiomyopathy, severe left ventricular dysfunction, and moderate mitral insufficiency who received a transfemoral Impella left ventricular assist device that was relocated to the right axillary artery due to uncontrolled femoral access bleeding. The patient immediately stabilized post-implantation and was successfully bridged to a full recovery 6 days later. Read More

    Iatrogenic takotsubo cardiomyopathy induced by locally applied epinephrine and cocaine.
    BMJ Case Rep 2014 Feb 19;2014. Epub 2014 Feb 19.
    Department of Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark.
    A 67-year-old man underwent surgery under general anaesthesia to obtain a biopsy from a tumour in the left maxillary sinus. Before the procedure a mucosal detumescence containing epinephrine and cocaine was applied onto the nasal mucosa. Shortly after termination of anaesthesia the patient developed tachycardia and an abrupt rise in blood pressure followed by a drop to critical levels. Read More

    Pathophysiological mechanisms of catecholamine and cocaine-mediated cardiotoxicity.
    Heart Fail Rev 2014 Nov;19(6):815-24
    Department of Intensive Care Medicine and Burn Center, Faculty of Biology and Medicine, University Hospital Medical Center, BH 08-621, 1010, Lausanne, Switzerland,
    Overactivation of the sympatho-adrenergic system is an essential mechanism providing short-term adaptation to the stressful conditions of critical illnesses. In the same way, the administration of exogenous catecholamines is mandatory to support the failing circulation in acutely ill patients. In contrast to these short-term benefits, prolonged adrenergic stress is detrimental to the cardiovascular system by initiating a series of adverse effects triggering significant cardiotoxicity, whose pathophysiological mechanisms are complex and only partially elucidated. Read More

    Dilated cardiomyopathy secondary to chronic cocaine abuse: a case report.
    BMC Res Notes 2013 Dec 17;6:536. Epub 2013 Dec 17.
    Department of Internal Medicine, Paul L, Foster School of Medicine, Texas Tech University Health Sciences Center at El Paso, El Paso, Texas, USA.
    Background: Cocaine is a potent sympathomimetic agent associated with the development of possible fatal cardiovascular complications. Dysrhythmias, acute myocardial infarction, hypertension and dilated cardiomyopathy are just some of many cardiovascular effects related to the abuse of cocaine.

    Case Presentation: A 38-year-old Hispanic male with a past medical history of hypertension presented with a chief complaint of progressive shortness of breath. Read More

    Influence of mitochondrion-toxic agents on the cardiovascular system.
    Regul Toxicol Pharmacol 2013 Dec 10;67(3):434-45. Epub 2013 Sep 10.
    Krankenanstalt Rudolfstiftung, Vienna, Austria. Electronic address:
    Cardiovascular disease may be induced or worsened by mitochondrion-toxic agents. Mitochondrion-toxic agents may be classified as those with or without a clinical effect, those which induce cardiac disease only in humans or animals or both, as prescribed drugs, illicit drugs, exotoxins, or nutritiants, as those which affect the heart exclusively or also other organs, as those which are effective only in patients with a mitochondrial disorder or cardiac disease or also in healthy subjects, or as solid, liquid, or volatile agents. In humans, cardiotoxic agents due to mitochondrial dysfunction include anthracyclines (particularly doxorubicin), mitoxantrone, cyclophosphamide, cisplatin, fluorouracil, imatinib, bortezomib, trastuzumab, arsenic trioxide, cyclosporine-A, zidovudine, lamotrigine, glycosides, lidocain, isoproterenol, nitroprusside, pivalic acid, alcohol, cocaine, pesticides, cadmium, mycotoxins, cyanotoxins, meat meal, or carbon monoxide. Read More

    "Bath salts" induced severe reversible cardiomyopathy.
    Am J Case Rep 2013 31;14:288-91. Epub 2013 Jul 31.
    Department of Internal Medicine, East Tennessee State University, Johnson City, TN, U.S.A.
    Patient: Male, 27 FINAL DIAGNOSIS: Bath salt induced cardiomyopathy Symptoms: Agitation • fever • pedal edema

    Medication: Intravenous nor-epinephrine for less than 6 hours Clinical Procedure: - Specialty: Internal medicine • cardiology.

    Objective: Unusual clinical course.

    Background: "Bath salts" is the street name for a group of recently identified and increasingly abused stimulant synthetic cathinones that are associated with multiple systemic effects. Read More

    [Sepsis, cardiomyopathy and human immunodeficiency virus infection: presentation of a case].
    Rev Esp Anestesiol Reanim 2014 Apr 23;61(4):214-8. Epub 2013 May 23.
    Servicio de Anestesiología, Reanimación y Tratamiento del Dolor, Consorcio Hospital General Universitario, Valencia, España.
    Sepsis in patients with human immunodeficiency virus (HIV) may be associated with the appearance of cardiac dysfunction. This is a challenge, both when making the differential diagnosis and determining the proper treatment, as there are numerous risk factors: Myocarditis due to the HIV itself, the presence or absence of highly active antiretroviral therapy, toxic substances, and cardiomyopathy associated with sepsis. The diagnostic and therapeutic approach to an HIV positive patient with septic shock and cardiac dysfunction is described, as well as a brief review of the different causes of cardiomyopathy which may affect this group of patients is also presented. Read More

    Elevated troponin levels in previously healthy children: value of diagnostic modalities and the importance of a drug screen.
    Cardiol Young 2014 Apr 5;24(2):283-9. Epub 2013 Mar 5.
    1 Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center at Dallas, Dallas, Texas, United States of America.
    Background: Myocardial injury in previously healthy children is rare, with a wide range of aetiologies. It is increasingly being identified on the basis of elevated troponin levels during routine evaluation of cardiorespiratory symptoms. Establishing the aetiology remains challenging because of the lack of an accepted work-up algorithm. Read More

    [Acute coronary syndrome and coronariography without significant lesions: do we know everything?].
    Med Clin (Barc) 2013 May 21;140(9):409-14. Epub 2012 Nov 21.
    Servicio de Cardiología, Hospital Universitario Nuestra Señora de Valme, Sevilla, España.
    Obstructive coronary artery disease is not detected in up to 14% of patients who present with acute coronary syndrome (ACS). Diagnosis of the underlying cause is usually not made and there is much controversy regarding prognosis. Those patients who develop ACS while having normal or near normal coronary arteries are more frequently young women and have fewer cardiovascular risk factors (CVRF). Read More

    Alcohol and drugs: twins or evil in a young heart.
    Acta Cardiol 2012 Aug;67(4):469-71
    Dept. of Cardiology, University Hospitals Leuven, Leuven, Belgium.
    We describe how the use of multiple drugs and excessive alcohol intake caused a dilated cardiomyopathy complicated by cardiogenic shock and life-threatening ventricular arrhythmias in an otherwise healthy young man. The diagnosis was made by exclusion of other causes of cardiomyopathy. Surprisingly an ischaemic scar without significant coronary artery disease was also found on cardiac MRI, most likely related to vasoactive drugs (cocaine). Read More

    Side effects of cocaine abuse: multiorgan toxicity and pathological consequences.
    Curr Med Chem 2012 ;19(33):5624-46
    Department of Forensic Pathology, University of Foggia, Ospedale C. D'Avanzo, Viale degli Aviatori 1, 71100, Foggia, Italy.
    Cocaine is a powerful stimulant of the sympathetic nervous system by inhibiting catecholamine reuptake, stimulating central sympathetic outflow, and increasing the sensitivity of adrenergic nerve endings to norepinephrine (NE). It is known, from numerous studies, that cocaine causes irreversible structural changes on the brain, heart, lung and other organs such as liver and kidney and there are many mechanisms involved in the genesis of these damages. Some effects are determined by the overstimulation of the adrenergic system. Read More

    Histological and immunohistochemical changes of the myocardium in dilated cardiomyopathy.
    Rom J Morphol Embryol 2012 ;53(2):269-75
    Department of Histology, University of Medicine and Pharmacy of Craiova, Craiova, Romania.
    Dilated cardiomyopathy is a major cause of heart failure and a major cause of morbidity and mortality. It is a multifactorial disease that includes both hereditary and acquired forms. It is estimated that around 20-35% of patients with dilated cardiomyopathy have hereditary forms. Read More

    Myocardial infarction with normal coronaries: an autopsy perspective.
    J Clin Pathol 2012 Jun 29;65(6):512-6. Epub 2012 Feb 29.
    Royal Brompton and Harefield Hospitals NHS Trust, London, UK.
    Aim: To analyse postmortem cases of myocardial infarction (MI) with normal coronary arteries in terms of patient characteristics, features of the MI and risk factors.

    Methods: This retrospective non-case controlled study was carried out at a specialist cardiac pathology department at a tertiary cardiac referral centre. Cases of histologically confirmed MI and normal coronary arteries during the period 1996-2010 were identified and analysed for the presence of risk factors. Read More

    Doping and thrombosis in sports.
    Semin Thromb Hemost 2011 Nov 23;37(8):918-28. Epub 2011 Dec 23.
    UO Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
    Historically, humans have long sought to enhance their "athletic" performance to increase body weight, aggressiveness, mental concentration and physical strength, contextually reducing fatigue, pain, and improving recovery. Although regular training is the mainstay for achieving these targets, the ancillary use of ergogenic aids has become commonplace in all sports. The demarcation between ergogenic aids and doping substances or practices is continuously challenging and mostly based on perceptions regarding the corruption of the fairness of competition and the potential side effects or adverse events arising from the use of otherwise unnecessary ergogenic substances. Read More

    Rethinking cocaine-associated chest pain and acute coronary syndromes.
    Mayo Clin Proc 2011 Dec;86(12):1198-207
    Department of Internal Medicine, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
    Every year more than 500,000 patients present to the emergency department with cocaine-associated complications, most commonly chest pain. Many of these patients undergo extensive work-up and treatment. Much of the evidence regarding cocaine's cardiovascular effects, as well as the current management of cocaine-associated chest pain and acute coronary syndromes, is anecdotally derived and based on studies written more than 2 decades ago that involved only a few patients. Read More

    Silent myocardial damage in cocaine addicts.
    Heart 2011 Dec 20;97(24):2056-62. Epub 2011 Jun 20.
    UO Risonanza Magnetica and UO Malattie cardiovascolari, Fondazione G Monasterio Regione Toscana CNR, Pisa, Italy.
    Background: Cocaine addiction is associated with either ischaemic or non-ischaemic cardiac complications. The prevalence of myocardial damage in asymptomatic addicts has never been evaluated by cardiovascular magnetic resonance (CMR), which allows non-invasive detection of myocardial oedema and fibrosis.

    Objective: To prospectively evaluate the prevalence of myocardial damage in cocaine addicts with no history of cardiac disease by CMR. Read More

    Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart.
    Am J Med 2011 Jun;124(6):480-8
    Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, Jefferson Medical College, Philadelphia, PA, USA.
    The heart is a target of injury for many chemical compounds, both medically prescribed and not medically prescribed. Pathophysiologic mechanisms underlying the development of chemical-induced cardiomyopathies vary depending on the inciting agent, including direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. Numerous chemicals and drugs are implicated in cardiomyopathy. Read More

    Trends and pattern of drug abuse deaths in Maryland teenagers.
    J Forensic Sci 2011 Jul 10;56(4):1029-33. Epub 2011 Mar 10.
    Key Laboratory of Evidence Science, China University of Political Science and Law, 100080 Beijing, China.
    The Office of the Chief Medical Examiner of Maryland recorded a total of 149 drug abuse deaths of teenagers aged 13-19 years between 1991 and 2006. Of these deaths, 96 (64.4%) were caused by the use of narcotic drugs only, 29 (19. Read More

    Topical vasoconstrictor use for nasal intubation during pregnancy complicated by cardiomyopathy and preeclampsia.
    Int J Obstet Anesth 2011 Jul 18;20(3):246-9. Epub 2011 Feb 18.
    Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, USA.
    Ankylosing spondylitis presents challenges for the obstetric anesthesiologist in administering neuraxial anesthesia or managing the airway. A pregnant patient with ankylosing spondylitis, cardiomyopathy and preeclampsia requiring cesarean delivery was managed with an awake nasotracheal fiberoptic intubation. The use of topical cocaine, epinephrine, phenylephrine, and oxymetazoline to produce nasal vasoconstriction is discussed. Read More

    "Awakenings": electrocardiographic findings in central sleep apnea.
    Ann Noninvasive Electrocardiol 2010 Oct;15(4):387-91
    Department of Internal Medicine, Carolinas Medical Center, Charlotte, NC 28232, USA.
    Central sleep apnea is an important but frequently missed clinical diagnosis. The purpose of this clinical case series is to demonstrate that in a subset of patients with central sleep apnea, inpatient telemetry ECG recordings may reveal a consistent relationship between changes in sinus rate, AV conduction, and the presence and rate of respiratory artifact that should raise the clinical suspicion of central sleep apnea. In the three presented cases, marked sinus bradycardia or AV block was followed by the simultaneous occurrence of abrupt acceleration of heart rate and the appearance of rapid micro-oscillations consistent with respiratory artifact. Read More

    Cocaine and the heart.
    Clin Cardiol 2010 May;33(5):264-9
    Albert Einstein Medical Center, Department of Cardiovascular Diseases, Philadelphia, Pennsylvania, USA.
    The use of cocaine may be associated with either acute or chronic toxicity, and approximately 5% to 10% of emergency department visits in the United States are believed to be secondary to cocaine usage. Chest pain is the most common cocaine-related medical problem, leading to the evaluation of approximately 64,000 patients annually for possible myocardial infarction, of which approximately 57% are admitted to the hospital, resulting in an annual cost greater than $83 million. There is a plethora of cocaine-related cardiovascular complications, including acute myocardial ischemia and infarction, arrhythmias, sudden death, myocarditis, cardiomyopathy, hypertension, aortic ruptures, and endocarditis. Read More

    Alcoholic and cocaine-associated cardiomyopathies.
    Prog Cardiovasc Dis 2010 Jan-Feb;52(4):289-99
    Cardiovascular Section Boston Medical Center, Boston, MA 02118, USA.
    Alcohol and cocaine use are associated with significant cardiovascular complications, including cardiomyopathy. The pathophysiologic mechanisms underlying the development of these toxic cardiomyopathies vary depending on the inciting agent but include direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. The typical patient with alcoholic cardiomyopathy is a long-term excessive alcohol consumer who is otherwise indistinguishable from other patients with nonischemic cardiomyopathy. Read More

    Cocaine-related sudden death: a prospective investigation in south-west Spain.
    Eur Heart J 2010 Feb 12;31(3):318-29. Epub 2010 Jan 12.
    Forensic Pathology Service, Institute of Legal Medicine, Seville, Spain.
    Aims: With an estimated 12 million consumers in Europe, cocaine (COC) is the illicit drug leading to the most emergency department visits. The aim of this study was to examine a consecutive series of sudden deaths (SDs) to focus on the prevalence, the toxicological characteristics, and the causes of death in COC-related fatalities.

    Methods And Results: Prospective case-control study of forensic autopsies was carried out in the time interval November 2003 to June 2006 at the Institute of Legal Medicine, Seville, south-west Spain, with a reference population of 1 875 462 inhabitants. Read More

    Neurotoxic and cardiotoxic effects of cocaine and ethanol.
    J Med Toxicol 2009 Sep;5(3):134-8
    Department of Neurology and Ophthalmology, Michigan State University, East Lansing, MI, USA.
    Introduction: Concurrent abuse of alcohol and cocaine results in the formation of cocaethylene, a powerful cocaine metabolite. Cocaethylene potentiates the direct cardiotoxic and indirect neurotoxic effects of cocaine or alcohol alone.

    Case Report: A 44-year-old female with history of cocaine and alcohol abuse presented with massive stroke in the emergency department. Read More

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