33. What are the cardiovascular implications of cocaine use (acute and chronic)?

Cocaine has a number of harmful cardiovascular effects. The main mechanism by which cocaine exerts these effects is via activation of the sympathetic nervous system. This results in profound hypertension and tachycardia at times leading to coronary vasospasm. The result can lead to acute myocardial infarction from increased oxygen demand or coronary vasospasm. Chronic cocaine use enhances the development of atherosclerosis. Treatment includes calcium channel blockers and the avoidance of beta-blockers so unopposed alpha agonism does not occur. Cocaine cardiomyopathy is similar to that of Takotsubo cardiomyopathy (stress induced cardiomyopathy).