| Manejo de los pacientes con arritmias inducidas por cocaína |
Treatment of patients with cocaine-induced arrhythmias: bringing the bench to the bedside.
Hoffman RS.
New York University School of Medicine, New York, USA.Bobhoffmd@gmail.com
Br J Clin Pharmacol. 2010 May;69(5):448-57.
Abstract
Widespread use of cocaine and its attendant toxicity has produced a wealth of benchwork studies and small animal investigations that evaluated the effects of cocaine on the cardiovascular system. Despite this wealth of knowledge, very little is known about the frequency or types of arrhythmias in patients with significant cocaine toxicity. The likely aetiologies; catecholamine excess, sodium channel blockade, potassium channel blockade, calcium channel effects, or ischaemia may act alone or in concert to produce a vast array of clinical findings that are modulated by hyperthermia, acidosis, hypoxia and electrolyte abnormalities. The initial paper in the series by Wood & Dargan providing the epidemiological framework of cocaine use and abuse is followed by a detailed review of the electrophysiological effects of cocaine by O'Leary & Hancox. This review is designed to complement the previous papers and focuses on the diagnosis and treatment of patients with cocaine-associated arrhythmias
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856045/pdf/bcp0069-0448.pdf |
| Papel de los canales de sodio dependientes de voltaje, potasio y calcio en el desarrollo de arritmias cardiacas asociadas a cocaína |
Role of voltage-gated sodium, potassium and calcium channels in the development of cocaine-associated cardiac arrhythmias.
O'Leary ME, Hancox JC.
Department of Pathology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, PA 19107, USA. michael.oleary@jefferson.edu
Br J Clin Pharmacol. 2010 May;69(5):427-42.
Abstract
Cocaine is a highly active stimulant that alters dopamine metabolism in the central nervous system resulting in a feeling of euphoria that with time can lead to addictive behaviours. Cocaine has numerous deleterious effects in humans including seizures, vasoconstriction, ischaemia, increased heart rate and blood pressure, cardiac arrhythmias and sudden death. The cardiotoxic effects of cocaine are indirectly mediated by an increase in sympathomimetic stimulation to the heart and coronary vasculature and by a direct effect on the ion channels responsible for maintaining the electrical excitability of the heart. The direct and indirect effects of cocaine work in tandem to disrupt the co-ordinated electrical activity of the heart and have been associated with life-threatening cardiac arrhythmias. This review focuses on the direct effects of cocaine on cardiac ion channels, with particular focus on sodium, potassium and calcium channels, and on the contributions of these channels to cocaine-induced arrhythmias. Companion articles in this edition of the journal examine the epidemiology of cocaine use (Wood & Dargan) and the treatment of cocaine-associated arrhythmias (Hoffmann).
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2856043/pdf/bcp0069-0427.pdf
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| Tratamiento de sobredosis de cocaína con emulsión de lípidos |
Treatment of cocaine overdose with lipid emulsion.
Jakkala-Saibaba R, Morgan PG, Morton GL.
Anaesthesia. 2011 Dec;66(12):1168-70. doi: 10.1111/j.1365-2044.2011.06895.x.
Abstract
We describe the management and recovery of a 28-year-old man following a history of overdose by nasal inhalation of cocaine. The patient was presented in a comatose state suffering from seizures and marked cardiovascularly instability. Intravenous lipid emulsion was administered following initial resuscitation and tracheal intubation, as a means of treating persistent cardiac arrhythmias and profound hypotension. Following lipid emulsion therapy, the patient's life-threatening cardiovascular parameters rapidly improved and he recovered well without any side effects, thus being days.
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