Cocaine abuse

Episodic cocaine use leads to short-lived states of autonomic arousal. Chronic use can lead to scarring of heart tissue and myocardial hypertrophy and other changes collectively known as myocardial remodeling. These changes constitute the substrate for the occurrence of lethal arrhythmias.

Cocaine binds to the hERG (rapid repolarizing potassium) channel, disrupting the normal process of depolarization in heart muscle. Cocaine should not, therefore, be used concomitantly with drugs known to cause QT interval prolongation

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 coronary artery disease.

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.

There is no evidence to support the use of antipsychotic agents for cocaine dependence. Antipsychotic agents may cause QT interval prolongation and, when used concomitantly with cocaine, may compound the risk of sudden death.

Cocaine is a drug of abuse that is usually either insufflated (snorted), injected, or smoked in its freebase form (crack). Cocaine is a type IA antidysrhythmic, local anesthetic, and sympathomimetic. It can also bind the hERG (slowly depolarizing inward potassium channel), which is prodysrhythmic.