Heart Attack High
How cocaine makes the heart a ‘ticking time bomb’— to the surprise of users
When Charlie* enrolled in a medication study at The University of Texas Health Science Center at Houston (UTHealth), he was hoping that maybe this time he really could defeat the cocaine addiction that had left him jobless and isolated from family and friends.
What he didn’t expect was to find out that his heart was protesting years of abuse at the hands of the drug. He had no idea that he already had suffered a heart attack and another artery was blocked, requiring surgery to implant two stents.
That knowledge, along with his own desire to leave cocaine behind, led him back onto a path toward health and loved ones.
“I went because of addiction problems,” says Charlie, who is in his early 50s. “I took an ECG [electrocardiograph] and it didn’t come out right. The nurse played a good role in providing me with things. She read the ECG and said we needed to take care of it. She explained it in terms I could understand. They saw to it that I went to a doctor and they were very concerned about me. They went the extra step.”
An ECG is standard for all patients entering UTHealth studies for addiction. The cocaine study Charlie completed was testing an inexpensive antidepressant, Citalopram, in combination with 12 weeks of counseling at UTHealth’s Center for Neurobehavioral Research on Addiction (CNRA). The Center is a designated site of the National Institute on Drug Abuse (NIDA), part of the National Institutes of Health.
NIDA estimates that in 2008, there were 1.9 million current cocaine users. Data from the 2008 Drug Abuse Warning Network showed that cocaine was involved in 482,188 of the nearly 2 million visits to emergency centers for drug misuse or abuse. Famous victims of heart disease related to cocaine use, according to autopsy reports, include pop star Whitney Houston and University of Maryland basketball player Len Bias. Researchers, including those in the Department of Psychiatry and Behavioral Sciences at UTHealth Medical School, have been looking at the physiological reasons for the link.
“NIDA has taken an interest in looking at biomarker changes we can measure that are associated in improvements in quitting the drugs,” says Joy Schmitz, PhD, lead investigator of the Citalopram study and professor of psychology and behavioral studies at UTHealth Medical School. “We know the changes are there but we haven’t really recorded them until now. For example, Charlie’s heart has shown improvement in the three months since he has abstained from cocaine. We’ve started to prove a link.”
In a retrospective study presented in May at the Texas Chapter of the American College of Cardiology meeting in Dallas, UTHealth cardiology fellow Jyoti Sharma, MD, reported that the incidence of bradycardia, a slower heart beat than normal, was markedly higher in cocaine-dependent subjects than in the control subjects. Bradycardia can cause a decrease in the amount of blood pumping through the heart, resulting in fainting, fatigue, shortness of breath, chest pains and, if severe enough, death.
“Chronic users have very slow heart rates and we’re trying to find out how that occurs,” says cardiologist Anne H. Dougherty, MD, professor of internal medicine at UTHealth Medical School and senior author of the retrospective study, which also included Schmitz and psychiatry professor Gerry Moeller, MD. “I look at the ECGs of these patients, and I’m struck by how many of them think they are normal. Their heart is beating only 40 times a minute like a trained athlete, but these people are not athletes.”
Dougherty says the theory is that cocaine affects the adrenalin response, which in turn disrupts the body’s automatic heart rhythm. The team is in the process of doing additional studies to learn more.
The slower heart rate is just one of the ways the heart can be affected. The immediate impact of cocaine causes the heart to speed up and increases the forcefulness of the contraction of the muscle. Meanwhile, the arteries tighten down so the blood pressure goes up. According to the NIDA, cocaine is responsible for more U.S. emergency room visits than any other illegal drug.
“You’re making the heart work double-time with less fuel,” Dougherty says. “Short term, that means you’re prone to a heart attack and rhythm problems. The heart muscle becomes angry. Cocaine patients will come into the emergency center with chest pain and some are having heart attacks. Some people will actually take downers so they don’t have that racing heart feeling.”
Studies also have shown that cocaine use speeds the process of arteriosclerosis, leading to kidney disease, stroke and heart attack. “The rising blood pressure caused by cocaine presses cholesterol against the artery walls. It makes the cardiovascular system very old very fast,” Dougherty adds.
In Charlie’s case, seeing the results of his cocaine use on his heart made a difference.
Schmitz says knowledge about their heart disease can be another motivation for patients battling a difficult addiction. Charlie’s heart has now returned to a normal rhythm, an additional incentive for him to stay drug-free.
The research team includes nurse practitioner Tammy Souter, nurse Ann Garcia and counselor Lauren Kitchens, who worked with Charlie during his treatment. UTHealth translates findings from cutting-edge research to the Multidisciplinary Outpatient Intensive Addiction Treatment (MOTIVATE) clinic, which treats people with addictive disorders, including smoking, alcoholism, the use of illegal substances and the abuse of prescription medications.
“So many times you go to a clinic and they really don’t have a relationship with you. Here they welcome you and show respect and care,” Charlie says. “I’m very happy inside. If not for this clinic, I would never have known I was a ticking time bomb. I’m gaining back the things I lost: my family and my friends. All my kids are back in the picture now.”
For more information on UTHealth studies at the CNRA, call 713-500-DRUG (713-500-3784).
*Charlie requested that he remain anonymous as he continues to rebuild his life.