Cardiovascular Section Boston Medical Center, Boston, MA 02118, USA.
Prog Cardiovasc Dis. 2010 Jan-Feb;52(4):289-99. doi: 10.1016/j.pcad.2009.11.004.
Alcohol and cocaine use are associated with significant cardiovascular complications, including cardiomyopathy. The pathophysiologic mechanisms underlying the development of these toxic cardiomyopathies vary depending on the inciting agent but include direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. The typical patient with alcoholic cardiomyopathy is a long-term excessive alcohol consumer who is otherwise indistinguishable from other patients with nonischemic cardiomyopathy. The typical patient with cocaine cardiomyopathy is a young male smoker who presents with signs of adrenergic excess. Management of these patients is similar to that of patients with other forms of dilated cardiomyopathy, although beta-blockers should be avoided in patients with cocaine-associated heart failure and benzodiazepines should be given in this setting to blunt adrenergic excess. Left ventricular function may improve dramatically with abstinence from alcohol or cocaine. Unfortunately, the rate of recidivism is high and left ventricular dysfunction and symptomatic heart failure often recurs.
酒精和可卡因的使用与重大心血管并发症有关，包括心肌病。这些中毒性心肌病发展的病理生理机制因引发剂而异，但包括直接毒性作用、神经激素激活、钙稳态改变和氧化应激。典型的酒精性心肌病患者是长期过量饮酒者，与其他非缺血性心肌病患者无法区分。典型的可卡因性心肌病患者是年轻的男性吸烟者，表现为肾上腺素能亢进的迹象。这些患者的管理与其他形式的扩张型心肌病患者相似，尽管应避免在可卡因相关心力衰竭患者中使用β受体阻滞剂，并且应在这种情况下给予苯二氮䓬类药物以减轻肾上腺素能亢进。戒酒或戒可卡因后左心室功能可能会显著改善。不幸的是，复发率很高，左心室功能障碍和有症状的心力衰竭经常复发。
