Summary

• Episodic cocaine use leads to short-lived states of autonomic arousal. Chronic use can lead to scarring of heart tissue and myocardial hypertrophy, with increased myocardial calcium content resulting in an increased risk for lethal arrhythmias and sudden death.
• Cocaine binds to the hERG (rapid repolarising potassium) channel, disrupting the normal process of depolarisation in heart muscle. This action can lead to a prolonged QT interval, favouring arrhythmias and sudden death, particularly in those with underlying myocardial pathology.
• While chest pain related to cocaine use is a common reason for seeking medical care, occasional use is rarely associated with acute myocardial infarction (AMI) unless there is pre-existing CAD.
• Psychosis can be seen in chronic users as an isolated condition or as a feature of 'excited delirium'. It is an agitated confusional state associated with potentially lethal hyperthermia.