How does cocaine affect the heart?

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Cocaine is a stimulant, which means that it elevates blood pressure and heart rate, in addition to making a person feel more energetic and alert. These changes affect how the heart functions in the short term.

Prolonged cocaine use, however, may cause long-term heart health issues.

The effects of cocaine on the heart include:

Coronary artery disease

Some, but not all, studies involving cocaine users suggest that cocaine may increase the risk of coronary artery disease (CAD). This disease causes blood vessels to narrow as a result of the buildup of plaque.

CAD is a risk factor for heart attack and stroke, as well as for sudden death. Cocaine users who have other risk factors — such as having overweight or eating an unhealthful diet — or who use cocaine for a long time may sustain further heart damage. This additional damage increases the risk of heart attack even more.

Cocaine can also cause coronary artery spasms that limit blood flow to the heart, possibly causing heart damage.

Higher blood pressure

Cocaine use can elevate blood pressure, increasing the risk of heart health problems and heart attack. A 2014 study suggests that this risk may exist even in people who are young and healthy and only use cocaine occasionally.

Damage to the structure of the heart

Cocaine use may damage the physical structures of the heart, either directly or by causing other serious issues, such as high blood pressure. A small 2014 study found that cocaine users who were otherwise young and healthy had enlarged left ventricles compared with non-users. They also had increased stiffness in the aorta, a major blood vessel of the heart.

This damage increases the risk of other heart health problems, such as irregular heart rate. It may also elevate the risk of heart attack.

Heart arrhythmias

People who use cocaine are more likely to have irregular or elevated heart rates. The reason for this may be that cocaine changes the sodium and potassium ion channels in the heart, affecting its electrical system. Many people who use cocaine may feel as though their heart is racing while under the influence. For some, this can cause anxiety.

Some research indicates that cocaine-related deaths increase in hot weather. The authors suggest that this is due to heat-induced heart rate changes triggering heart rhythm issues.

Chest pain

Cocaine users may be more likely to experience chest pain under the influence of cocaine or because of the chronic health effects of the drug.

Causes of cocaine-associated chest pain include heart rhythm abnormalities, changes in the body’s demand for oxygen, heart attack, spasms of the arteries around the heart, and heart infections.

Congestive heart failure

Congestive heart failure is a chronic medical condition that some people develop after a history of cocaine use. In those with this condition, the heart muscle cannot effectively pump blood. Over time, this can lead to serious complications, such as organ failure.

Heart attack and stroke

The damage that cocaine does to the heart and blood vessels increases the risk of heart attack and stroke. High blood pressure, coronary heart disease, and similar risk factors all increase a person’s risk of heart attack and stroke.

Cocaine also blocks certain sodium and potassium channels that affect heart functioning. In this way, it may damage the heart over time or cause abnormal heart rhythms that increase the risk of heart attack and other injuries.

A 2018 study suggests that cocaine may also increase the risk of heart attack in young people who would otherwise be at low risk. The study included 2,097 people under the age of 50 years who had had a heart attack.

The participants who used illegal drugs, such as cocaine, had fewer traditional heart health risk factors, including diabetes. Despite this, they were still twice as likely to die in the years following their heart attack.

About 5% of the participants had used cocaine before their heart attack. This fact suggests, though does not prove, that cocaine may trigger heart attack in some people.

Heart disease and symptoms of heart health problems are very serious. A person who uses cocaine should see a doctor if:

• they have cocaine use disorder and want help to quit
• they have cocaine use disorder and other risk factors for heart disease, such as diabetes or high blood pressure
• they have a history of unusual heart rhythms
• they are undergoing treatment for heart health issues, and their symptoms are worsening

A person using cocaine should seek emergency medical attention if:

• they experience sudden, intense chest pain and shortness of breath, especially when under the influence of the drug
• they lose consciousness, feel or seem confused, or experience numbness on one side of the body
• they have trouble breathing or feel as though they cannot catch their breath
• they think that they may have overdosed on cocaine or another drug

Learn more about treatments for addiction here.

Cocaine is a dangerous and potentially deadly drug.

Any cocaine use can undermine heart health, but chronic, frequent use presents the biggest risk.

Drug use disorders are real medical conditions, and treatment will often work. People who feel compelled to keep using cocaine should see a compassionate medical professional who specializes in addiction.