Cocaine and the Heart

Cocaine can increase the risk for many heart conditions, including high blood pressure, heart attack and rhythm problems. Many of these conditions can be deadly.

Regular cocaine use will impact a person’s physical health in different ways. However, using cocaine even once can be fatal, as the heart is especially vulnerable to cocaine’s effects.

How Does Cocaine Affect the Heart?

Cocaine impacts the heart in a few ways. Cocaine harms the heart by causing some important hormones in the body called catecholamines to become unbalanced. Cocaine stops the body from getting rid of the catecholamines as quickly as it usually would. Therefore, the catecholamines stay in a person’s body longer than normal, where they can then cause damage to the heart.

These chemicals include:

• Norepinephrine (noradrenaline): The chemical norepinephrine is important to your fight-or-flight response and causes an increase in heart rate and blood pressure.
• Serotonin: The chemical serotonin has a variety of effects on the heart. It increases heart rate, heart contractions and can cause rhythm problems and clots.
• Dopamine: Dopamine causes the heart to contract with more intensity, which causes blood pressure to increase.

Each of these hormones has a powerful effect on the heart, blood vessels and central nervous system. Together, these hormones trigger the body’s fight-or-flight response. Cocaine’s side effects on the body are, therefore, very similar to symptoms of the fight-or-flight response:

• High blood pressure
• Fast heartbeat
• Big pupils
• Trouble sleeping or relaxing
• Loss of appetite

In addition, cocaine interferes with chemicals that the heart needs to beat correctly. These chemicals includecalcium, sodium and potassium. By causing problems with these chemicals, cocaine use can lead to an abnormal heart rhythm.

Cocaine and Hypertension

Blood pressure refers to the amount of force with which blood is pushed against your arteries as your heart pumps. A normal blood pressure reading is 120/80 or lower. However, blood pressure can spike dangerously high at times, including when a person uses cocaine.

Cocaine causes high blood pressure because it triggers the release of catecholamines like norepinephrine, serotonin and dopamine. When a person takes cocaine and catecholamines are released, their blood vessels contract. This contraction makes blood vessels skinnier. However, blood vessels still need to carry the same amount of blood, even though they are skinnier than before. The person’s blood pressure goes up because their heart needs to use extra force to push the blood through smaller blood vessels.

Related Topic: Does Cocaine Cause Vasoconstriction?

Cocaine and Irregular Heartbeat

An irregular heartbeat, or arrhythmia, might be described as your “heart feeling weird” after using cocaine, or it may feel like your heart rate is speeding up or slowing down.

Cocaine changes the heart rhythm by blocking the flow of sodium and potassium ions in the heart muscles. The heart has a specialized cell called pacemaker cells that maintain heart rhythm. They do this by passing a small electrical charge between cells. The charge tells the heart muscle cells when to beat.

Pacemaker cells pass their charges to each other by moving sodium and potassium ions into and out of their cell membranes. Cocaine blocks the flow of sodium cells through heart cell membranes. When sodium ions cannot pass through, the electrical charge cannot move from cell to cell. The heartbeat then becomes irregular.

Types of Arrhythmias

The heart relies on precise electrical conduction to function and pump blood. Cocaine has been shown to produce several types of arrhythmias. Some examples include:

• Asystole: The absence of a heartbeat: asystole is often fatal because it means the heart has completely stopped beating or cardiac arrest.
• Bundle branch block: The electrical impulses that pace the heart are slowed down somewhere along their normal pathway. The electrical signals still generate a heart rhythm, but it might be slow or irregular. If the block is serious enough, it can progress to a full heart block and asystole. There might be no symptoms with heart block, or there might be an irregular heartbeat.
• Sinus bradycardia: The heart beats too slowly. The heart normally beats between 60 to 100 beats per minute (bpm). Bradycardia is a heartbeat of less than 60 bpm.
• Sinus tachycardia: The heart beats too fast. Tachycardia is when the heart rate is above 100 bpm.
• Ventricular fibrillation: The heart quivers instead of producing a beat or pumping blood. Quivering happens because electric signals become disorganized and do not fire in a rhythmic pattern. Ventricular fibrillation usually results in cardiac arrest.

Symptoms of Arrhythmias

Arrhythmias are most likely to happen within the first few hours of taking cocaine. Arrhythmias are difficult to predict and can be deadly. If you suspect you or a loved one is experiencing an arrhythmia after using cocaine, call 911. Some symptoms of arrhythmias include:

• Bradycardia, or slower than normal heartbeat
• Chest pain
• Dizziness or lightheadedness
• Shortness of breath
• Sweating
• Tachycardia, or faster than normal heartbeat

Preventing and Treating Arrhythmias from Cocaine Use

Heart arrhythmias from cocaine can only be prevented by not using cocaine. If you have experienced arrhythmia symptoms and are using cocaine, it is dangerous to continue using it.

Arrhythmias are treated in a hospital or emergency department. The medical team will use medications to correct the abnormal heart rate. If the arrhythmia leads to cardiac arrest, CPR and Advanced Cardiac Life Support (ACLS) techniques may be used. An Automated External Defibrillator (AED) might be used if the arrhythmias is a shockable rhythm. An AED sends a small electrical charge through the chest wall to stop arrhythmias and allow the heart to correct its own rhythm.

Cardiac arrest is often fatal, so treatment for cocaine addiction should be considered if you experience heart arrhythmias.

Cocaine and Stroke

Studies have shown that cocaine use can cause a stroke. A stroke can happen instantly after someone uses cocaine or a few hours later. About 73% of people who have a stroke from cocaine use do not have any risk factors for stroke other than their drug use. Doctors are not sure what exactly causes the stroke to happen. However, doctors suspect that some of the impure chemicals that contaminate cocaine may play a role in strokes from cocaine. Cocaine use can cause two different kinds of stroke:

• Ischemic stroke: from a blood vessel that is blocked or too narrow for blood to pass-through
• Hemorrhagic stroke: from bleeding in the brain

Each of these kinds of strokes can possibly have deadly consequences. Depending on the location of the stroke and how severe it is, the stroke can lead to brain damage or death.

Cocaine and Heart Attack

Cocaine has been called “the perfect heart-attack drug.” Even if a person does not use cocaine often, studies showed that chronic use leads to heart and blood vessel changes, setting a person up for a heart attack or stroke.These changes can happen even if a person is otherwise healthy. Changes include:

• Stiff, unhealthy blood vessels
• High blood pressure
• Changes to the heart that cause it to not pump well over time

In addition, cocaine use can cause the heart’s blood vessels to spasm and promote clots. Together, these can lead to blocked blood vessels that cause a heart attack. This process often happens within an hour of cocaine use.

Cocaine and Cardiac Arrest

Heart problems like a cardiac arrest can occur even if you don’t use cocaine regularly. It’s possible to go into cardiac arrest the first time that cocaine is used. Heart problems can occur as soon as a few minutes after cocaine use and as late as a few days after use.

Most cardiac arrest events caused by cocaine are linked to a combination of heart problems that cocaine can cause. A person does not need to have all of these problems, or even most of them, to experience cardiac arrest from cocaine use. These heart problems include:

• Fast heartbeat
• Abnormal heart rhythm
• A rapid increase in blood pressure
• Narrowing of the blood vessels
• Spasms in the arteries
• Inflammation of the heart
• Enlarged heart
• Heart attack

Cocaine can cause a heart attack even if the heart is otherwise healthy. One study found that almost 40% of people who experienced a heart attack from cocaine use had healthy arteries.

Symptoms of Cardiac Arrest from Cocaine Use

Cardiac arrest itself often has no symptoms. However, cocaine users whose hearts are harmed by cocaine use may complain of chest pain before going into cardiac arrest. Cardiac arrest requires emergency medical treatment. If cardiac arrest is suspect, emergency medical services should be called immediately.

Unfortunately, people frequently do not survive experiencing cardiac arrest. If someone does survive cardiac arrest, they may have long-lasting health problems like brain damage from the lack of oxygen.

Other Cardiovascular Concerns

Myocardial Infarction

Cocaine can cause a myocardial infarction, more commonly known as a heart attack. This happens from several different mechanisms that come together in a perfect storm. First, cocaine is known to cause narrowing of the blood vessels and arteries. In addition, cocaine makes the heart beat harder and faster. Cocaine can also cause plaque buildup in blood vessels. Together, these effects starve the heart of needed oxygen, leading to a heart attack. Drinking alcohol can worsen matters substantially: drinking while using cocaine can increase the risk of a heart attack by a factor of 40.

Aortic Dissection

An aortic dissection is a tear in the aorta, the body’s largest artery. Dissections, or tears, of the aorta and other blood vessels in the body, can occur with cocaine use. Although uncommon, it can occur with crack cocaine due to high blood pressure and high levels of catecholamine chemicals like norepinephrine, dopamine and serotonin.

Coronary Artery Aneurysm

The coronary arteries supply blood and oxygen to the heart and are crucial for keeping the heart-healthy. Cocaine can cause damage to these arteries in the form of coronary artery aneurysms, or bulging of the arteries. If the bulging artery ruptures, death can occur. One study found that nearly one-third of people who use cocaine have a coronary artery aneurysm.

Myocarditis and Cardiomyopathy

Chronic cocaine use is linked to myocarditis, an inflammation of the heart muscle, and cardiomyopathy, an enlargement of the heart. These conditions can reduce cardiac output and may lead to heart failure, a potentially deadly condition.

Cocaine and Sudden Cardiac Death

Sudden cardiac death from cocaine is unfortunately common. Experts think this is linked to cocaine causing a rapid heartbeat and rhythm problems. Alcohol is a known risk factor for sudden cardiac death from cocaine: drinking alcohol can increase the risk of this condition by a factor of 25.

Heart Condition Treatment Complications for Cocaine Users

Cardiovascular emergencies like a heart attack are serious enough on their own. However, using cocaine can compound the problem. It can be more difficult for doctors to treat your heart condition because of cocaine’s effects on the body.

Beta-Blockers

Beta-blockers are a common type of heart medication used for problems ranging from heart attack to high blood pressure to heart rhythm disorders. However, many doctors fear using beta-blockers in a person who uses cocaine. This is because cocaine’s effects on the heart pose a risk of a paradoxical increase in blood pressure and blood vessel constriction. Although some doctors refuse to use any beta-blockers in a person who has used cocaine, other doctors will use the beta-blocker labetalol if it is available.

Related Topic: Does Cocaine Affect Beta-Blockers?

Clot-Busting Drugs

Fibrinolytic drugs, known colloquially as clot-busters, are sometimes used to break up clots in people suffering from a heart attack or stroke. However, cocaine increases the risk of complications if fibrinolytics are used. Specifically, cocaine increases the risk of intracerebral hemorrhage, a severe type of brain bleed, if a fibrinolytic drug is given.

Stents

When doctors are trying to keep a blood vessel open, they will often implant a stent. In general, a type of stent called a drug-eluting stent is preferred since there is less chance of a blockage forming. However, people on a drug-eluting stent need to be on a specific blood-thinning medication regimen. Some doctors fear that a person struggling with substance abuse may not be able to adequately adhere to this regimen, increasing the chance that the stent will fail. For this reason, doctors may instead implant a bare-metal stent, which has a higher risk of blockage compared to a drug-eluting stent. However, it may be safer to use in a person who struggles with cocaine.

Find the Help You Need

If you or a loved one struggles with cocaine use, contact The Recovery Village today. The health risks of sustained cocaine use are too severe to ignore. Professional, evidence-based treatment is the best way to address cocaine addiction. You deserve a healthier future: call today.

Editor – Melissa Carmona

Melissa Carmona puts years of writing and editing experience to work helping people understand substance abuse, addiction and mental health disorders. Read more

Medically Reviewed By – Dr. Jessica Pyhtila, PharmD

Dr. Jessica Pyhtila is a Clinical Pharmacy Specialist based in Baltimore, Maryland with practice sites in inpatient palliative care and outpatient primary care at the Department of Veteran Affairs. Read more