Nademanee K, Gorelick D A, Josephson M A, Ryan M A, Wilkins J N, Robertson H A, Mody F V, Intarachot V
West Los Angeles Veterans Administration Medical Center, California.
Ann Intern Med. 1989 Dec 1;111(11):876-80. doi: 10.7326/0003-4819-111-11-876.
To determine the prevalence of myocardial ischemia in patients with cocaine addiction.
Myocardial ischemia in chronic cocaine users was detected by serial 24-hour electrocardiographic ambulatory (Holter) monitoring and exercise treadmill testing in chronic cocaine users. The Holter tapes were coded, scanned in a blinded manner, and mixed with the tapes of 42 normal volunteers and 119 patients with either stable or unstable angina.
A 28-day inpatient, substance abuse treatment program followed by an outpatient treatment program.
Twenty-one consecutive male chronic cocaine users.
Eight of the 21 patients with cocaine addiction had frequent episodes of ST elevation during Holter monitoring; these episodes occurred almost exclusively during the first 2 weeks of withdrawal. None of the volunteers and patients with stable angina and only 4% of the patients with unstable angina had episodes of ST elevation during Holter monitoring (cocaine users compared with volunteers, P = 0.0004). Of the 20 cocaine patients who had exercise treadmill testing, only 1 had a positive test for ischemia.
Cocaine users frequently develop silent myocardial ischemia manifesting as episodes of ST elevation during the first weeks of withdrawal. The underlying mechanisms for these changes remain unknown, but our observations support the hypothesis that coronary vasospasm plays an important role in cocaine-related ischemic syndromes.
确定可卡因成瘾患者中心肌缺血的患病率。
通过对慢性可卡因使用者进行连续24小时动态心电图（Holter）监测和运动平板试验来检测慢性可卡因使用者的心肌缺血情况。Holter磁带进行编码，以盲法扫描，并与42名正常志愿者以及119名稳定型或不稳定型心绞痛患者的磁带混合。
一个为期28天的住院药物滥用治疗项目，随后是门诊治疗项目。
21名连续的男性慢性可卡因使用者。
21名可卡因成瘾患者中有8名在Holter监测期间频繁出现ST段抬高；这些发作几乎仅发生在戒断的前2周。志愿者以及稳定型心绞痛患者中均无在Holter监测期间出现ST段抬高的情况，不稳定型心绞痛患者中仅有4%出现ST段抬高（可卡因使用者与志愿者相比，P = 0.0004）。在进行运动平板试验的20名可卡因患者中，只有1名缺血试验呈阳性。
可卡因使用者在戒断的最初几周经常出现无症状心肌缺血，表现为ST段抬高发作。这些变化的潜在机制尚不清楚，但我们的观察结果支持冠状动脉痉挛在可卡因相关缺血综合征中起重要作用这一假说。
