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Old 11-18-2013
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Help Cocaine induced angina ?

Type of angina in cocaine intake is STABLE or Prinzmetal's angina ?
Can anyone explain the mechanism behind it ?
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Prinzemetal.

Mechanism: Prinzemetal agina is due to vasospastic coronary arteries. Think of a patient with Asthma. they have hyperactive bronchial smooth muscles...so you contraindicate beta-blockers as that would exacerbate the situation. Well same thing here. You have hyperactive vasopastic coronary arteries, so anything that increases cathecholamines (cocaine) would exacerbate Prinzemetal's Angina.
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Cocaine inhibits NE reuptake so it acts on sympathetic system. It causes vasospasm -> Variant angina.
Cocaine does not act directly on the atheromatous plaque.
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Thank you guys !
I had the same understanding .. the thing is Goljan mentions 'cocaine abuse' in his book as one of the causes of Stable angina , so I was like !!
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Quote:
Originally Posted by hope007 View Post
Thank you guys !
I had the same understanding .. the thing is Goljan mentions 'cocaine abuse' in his book as one of the causes of Stable angina , so I was like !!
This is true because cocaine causes hypertension and thus the chronic exposure can, indirectly, promotes the development of a plaque.
However, always consider the age of the patient. A young patient wt an acute exposure it is plausible to be a variant angine. Otherwise if it is a middle age pt wt a note cv risk factors history, it could be an organic angina.
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