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Ann Intern Med. 1990 Jun 15;112(12):897-903.

Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade.

Author information

1
University of Texas Southwestern Medical Center, Parkland Memorial Hospital, Dallas.

Abstract

STUDY OBJECTIVE:

To determine whether beta-adrenergic blockade augments cocaine-induced coronary artery vasoconstriction.

DESIGN:

Randomized, double-blind, placebo-controlled trial.

SETTING:

A cardiac catheterization laboratory in an urban teaching hospital.

PATIENTS:

Thirty clinically stable patient volunteers referred for catheterization for evaluation of chest pain.

INTERVENTIONS:

Heart rate, arterial pressure, coronary sinus blood flow (by thermodilution), and epicardial left coronary arterial dimensions were measured before and 15 minutes after intranasal saline or cocaine administration (2 mg/kg body weight) and again after intracoronary propranolol administration (2 mg in 5 minutes).

MEASUREMENTS AND MAIN RESULTS:

No variables changed after saline administration. After cocaine administration, arterial pressure and rate-pressure product increased; coronary sinus blood flow fell (139 +/- 28 [mean +/- SE] to 120 +/- 20 mL/min); coronary vascular resistance (mean arterial pressure divided by coronary sinus blood flow) rose (0.87 +/- 0.10 to 1.05 +/- 0.10 mm Hg/mL.min); and coronary arterial diameters decreased by between 6% and 9% (P less than 0.05 for all variables). Subsequently, intracoronary propranolol administration caused no change in arterial pressure or rate-pressure product but further decreased coronary sinus blood flow (to 100 +/- 14 mL/min) and increased coronary vascular resistance (to 1.20 +/- 0.12 mm Hg/mL.min) (P less than 0.05 for both).

CONCLUSIONS:

Cocaine-induced coronary vasoconstriction is potentiated by beta-adrenergic blockade. Beta-adrenergic blocking agents probably should be avoided in patients with cocaine-associated myocardial ischemia or infarction.

PMID:
1971166
DOI:
10.7326/0003-4819-112-12-897
[Indexed for MEDLINE]

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