Complications
Peripherally, increase in catecholamines results in tachycardia, increased inotropy, and vasoconstriction, including coronary artery vasoconstriction. This vasospasm, as well as increased myocardial oxygen demand, increased thrombogenesis, and atherosclerosis from chronic cocaine use, contribute to cocaine-induced myocardial ischaemia.[54][55]
If acute coronary syndrome occurs then the patient should receive care from a cardiologist as well as referral for cocaine detoxification. Benzodiazepines (which may be used in cocaine toxicity for other reasons) may also have a relieving effect on angina chest pain.[22]
In individuals who have large exposures or unique susceptibility to cocaine, a lethal dysrhythmia or seizure may occur within seconds to minutes of use.
Cocaine increases platelet aggregation and is associated with accelerated atherosclerosis.[54][55][56]
If ischaemic CVA occurs the patient will need routine care (in consultation with a neurologist) and referral for cocaine detoxification.
Cerebrovascular accident in the setting of cocaine use should be managed in consultation with a neurologist or a neurosurgeon.
Intracranial haemorrhages after cocaine use are often caused by hypertension or ruptured aneurysms.
Supportive care is the standard treatment as well as referral to a pulmonologist if indicated.
Treatment of rhabdomyolysis after using cocaine is the same as for any other cause.
The aetiology of cocaine cardiomyopathy is not clear. It may be directly from cocaine, a result of multiple small infarcts, or both.
If this occurs, patient should receive routine care (hold beta-blockers in active users), as well as referral for cocaine detoxification
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