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(Circulation. 1998;97:1270-1273.)
© 1998 American Heart Association, Inc.

Clinical Investigation and Reports

Effects of the Intracoronary Infusion of Cocaine on Left Ventricular Systolic and Diastolic Function in Humans

William R. Pitts, MD; Wanpen Vongpatanasin, MD; Joaquin E. Cigarroa, MD; L. David Hillis, MD; ; Richard A. Lange, MD

From the Department of Internal Medicine (Cardiovascular Division), University of Texas Southwestern Medical Center, and the Cardiac Catheterization Laboratory, Parkland Memorial Hospital, Dallas, Tex.

Correspondence to Richard A. Lange, MD, Room CS 7.102, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75235-9047.

Background—In dogs, a large amount of intravenous cocaine causes a profound deterioration of left ventricular (LV) systolic function and an increase in LV end-diastolic pressure. This study was done to assess the influence of a high intracoronary cocaine concentration on LV systolic and diastolic function in humans.

Methods and Results—In 20 patients (14 men and 6 women aged 39 to 72 years) referred for cardiac catheterization for the evaluation of chest pain, we measured heart rate, systemic arterial pressure, LV pressure and its first derivative (dP/dt), and LV volumes and ejection fraction before and during the final 2 to 3 minutes of a 15-minute intracoronary infusion of saline (n=10, control subjects) or cocaine hydrochloride 1 mg/min (n=10). No variable changed with saline. With cocaine, the drug concentration in blood obtained from the coronary sinus was 3.0±0.4 (mean±SD) mg/L, similar in magnitude to the blood cocaine concentration reported in abusers dying of cocaine intoxication. Cocaine induced no significant change in heart rate, LV dP/dt (positive or negative), or LV end-diastolic volume, but it caused an increase in systolic and mean arterial pressures, LV end-diastolic pressure, and LV end-systolic volume, as well as a decrease in LV ejection fraction.

Conclusions—In humans, the intracoronary infusion of cocaine sufficient in amount to achieve a high drug concentration in coronary sinus blood causes a deterioration of LV systolic and diastolic performance.

Key Words: cocaine • ventricles • systole • diastole

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