eMedicine Specialties > Cardiology > Myocardial Disease and Cardiomyopathies

Cardiomyopathy, Cocaine: Follow-up

Author: Michal Kazimir, MD, Staff Physician, Department of Internal Medicine, Lehigh Valley Hospital
Coauthor(s): Paul A Janson, MD, Instructor, Tufts University School of Medicine; Director, EMT/RN Consultants; Consulting Staff, Department of Emergency Medicine, Lawrence General Hospital; James V Talano, MD, MM, FACC, Director of Cardiovascular Medicine, SWICFT Institute; Carla Vaccaro, MD, Consulting Staff, Department of Family Practice, Merrimack Family Medicine
Contributor Information and Disclosures

Updated: Mar 24, 2008

Follow-up

Further Inpatient Care

  • Complications of substance abuse
    • As previously mentioned, control of the cocaine addiction is mandatory. This may require continued inpatient care for control of the substance abuse.
    • Endocarditis is possible if the drug was used intravenously, and this should be considered if the anticipated improvement does not occur.
    • Other complications of drug use also should be considered (hepatitis, HIV infection).
  • As improvement occurs, treatment should be tapered.
    • Withdraw pressor and inotropic agents.
    • Transfer from intravenous to oral diuretics and vasodilators.
    • At the time of discharge, some patients may require no therapy at all.

Further Outpatient Care

  • Diuretic or vasodilators (ACE inhibitors) may be helpful in some cases but are not always needed. Therapy is highly individualized because the severity of the residual cardiac dysfunction is quite variable. Consider issues of compliance. The use of beta-blockers, which would ordinarily be considered in the treatment of congestive heart failure, probably should be avoided.
  • Outpatient treatment of drug abuse issues is of extreme importance, and every effort should be made to assist the patient in this regard. Recurrent congestive heart failure has been reported in patients who return to cocaine use.

Transfer

  • Transfer to a tertiary care center may be necessary if the patient is particularly unstable.

Deterrence/Prevention

  • Abstinence from further use of cocaine is the mainstay of prevention of this disease, both initially and for recurrence.

Complications

  • Complications include embolic disease, both cerebral and in other organs. Other complications related to drug use should be anticipated.

Prognosis

  • The cardiomyopathy appears to be largely reversible with abstinence from cocaine use.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Failure to consider substance abuse as the etiology of the cardiomyopathy
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Camille Michals, LSW to the development and writing of this article.



More on Cardiomyopathy, Cocaine

Overview: Cardiomyopathy, Cocaine
Differential Diagnoses & Workup: Cardiomyopathy, Cocaine
Treatment & Medication: Cardiomyopathy, Cocaine
Follow-up: Cardiomyopathy, Cocaine
References
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References

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Further Reading

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Keywords

cocaine cardiomyopathy, cocaine myocarditis, cocaine-induced heart failure, chronic cardiomyopathy, cocaine abuse, cocaine addiction

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Contributor Information and Disclosures

Author

Michal Kazimir, MD, Staff Physician, Department of Internal Medicine, Lehigh Valley Hospital
Michal Kazimir, MD is a member of the following medical societies: American College of Cardiology, American College of Physicians, and American Heart Association
Disclosure: Nothing to disclose.

Coauthor(s)

Paul A Janson, MD, Instructor, Tufts University School of Medicine; Director, EMT/RN Consultants; Consulting Staff, Department of Emergency Medicine, Lawrence General Hospital
Paul A Janson, MD is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians
Disclosure: Nothing to disclose.

James V Talano, MD, MM, FACC, Director of Cardiovascular Medicine, SWICFT Institute
James V Talano, MD, MM, FACC is a member of the following medical societies: American College of Cardiology, American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American Heart Association, American Society of Echocardiography, American Society of Nuclear Cardiology, Heart Failure Society of America, and Society of Geriatric Cardiology
Disclosure: Nothing to disclose.

Carla Vaccaro, MD, Consulting Staff, Department of Family Practice, Merrimack Family Medicine
Carla Vaccaro, MD is a member of the following medical societies: Massachusetts Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Gary E Sander, MD, PhD, Professor, Department of Internal Medicine, Division of Cardiology, Tulane University Health Sciences Center
Gary E Sander, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Hypertension, Heart Failure Society of America, Louisiana State Medical Society, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center
Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Patrice Delafontaine, MD, FACC, FAHA, FACP, FESC, Sidney W and Marilyn S Lassen Professor of Cardiovascular Medicine, Chief, Section of Cardiology, Director, Cardiovascular Center of Excellence, Tulane University; Professor of Physiology, Chair, Department of Medicine, Tulane University School of Medicine
Patrice Delafontaine, MD, FACC, FAHA, FACP, FESC is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians, American Diabetes Association, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Medical Association, American Society for Clinical Investigation, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Endocrine Society, European Society of Cardiology, Louisiana State Medical Society, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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