Isner J M, Estes N A, Thompson P D, Costanzo-Nordin M R, Subramanian R, Miller G, Katsas G, Sweeney K, Sturner W Q
N Engl J Med. 1986 Dec 4;315(23):1438-43. doi: 10.1056/NEJM198612043152302.
The increasingly widespread use of cocaine in the United States has been accompanied and perhaps exacerbated by the misconception that the drug is not associated with serious medical complications. In particular, the potential for cocaine to precipitate life-threatening cardiac events needs to be reemphasized. We report the clinical and pathological findings in seven people in whom nonintravenous "recreational" use of cocaine was temporally related to acute myocardial infarction, ventricular tachycardia and fibrillation, myocarditis, sudden death, or a combination of these events. We also review data on 19 previously reported cases of cocaine-related cardiovascular disorders. Analysis of all 26 patients indicated the following findings: the cardiac consequences of cocaine abuse are not unique to parenteral use of the drug, since nearly all the patients took the drug intranasally; underlying heart disease is not a prerequisite for cocaine-related cardiac disorders; seizure activity, a well-documented noncardiac complication of cocaine abuse, is neither a prerequisite for, nor an accompanying feature of, cardiac toxicity of cocaine; and the cardiac consequences of cocaine are not limited to massive doses of the drug. Although the pathogenesis of cardiac toxicity of cocaine remains incompletely defined, available circumstantial evidence suggests that cocaine has medical consequences that are equal in importance to its well-documented psychosocial consequences.
在美国，可卡因的使用日益广泛，与此同时，或许是这种情况加剧了人们的一种误解，即该药物不会引发严重的医学并发症。尤其是，可卡因引发危及生命的心脏事件的可能性需要再次强调。我们报告了7例非静脉注射“娱乐性”使用可卡因的患者，这些患者的使用时间与急性心肌梗死、室性心动过速和颤动、心肌炎、猝死或这些事件的组合存在时间关联。我们还回顾了之前报告的19例与可卡因相关的心血管疾病病例的数据。对所有26例患者的分析表明了以下结果：可卡因滥用对心脏造成的影响并非静脉注射该药物所特有，因为几乎所有患者都是通过鼻内用药；潜在的心脏病并非可卡因相关心脏疾病的先决条件；癫痫发作是可卡因滥用一种有充分记录的非心脏并发症，它既不是可卡因心脏毒性的先决条件，也不是其伴随特征；可卡因对心脏造成的影响并不局限于大剂量用药。尽管可卡因心脏毒性的发病机制仍未完全明确，但现有的间接证据表明，可卡因造成的医学后果与其有充分记录的社会心理后果同样重要。
