1. Cocaine and the Heart

2. Intro In 2014: 39,200 million Americans - 12 and older have admitted to using cocaine at least once in their life. 9,424 million reported using crack-cocaine. http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpbs http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpbs In 2009, almost one million visits involved an illicit drug, either alone or in combination with other types of drugs. DAWN estimates that— cocaine was involved in 422,896 ED visits http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits http://www.drugabuse.gov/publications/drugfacts/drug-related-hospital-emergency-room-visits

3. Finally, in 2000, the first significant decline in cocaine use in several years was observed; annual prevalence among 12th graders dropped to 5.0% and then leveled at about that level through 2007, before declining again and reaching 2.6% by 2013." - See more at: http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpuf http://www.drugwarfacts.org/cms/Cocaine#sthash.A8NFjO6K.dpuf Some Good News

4. Pharmacology Cocaine hydrochloride is well absorbed through all mucous membranes As compared to the intravenous route, mucosal administration results in slower onset of action, later peak effect and a longer duration of action Euphoria is almost immediate after crack cocaine is smoked Crack cocaine is considered the most addictive form of the drug

5. Cocaine blocks Cocaine blocks the reuptake of norepinephrine by the neuron (red X), resulting in excess amounts of this neurotransmitter at receptor sites on the effector cell. Short videoShort video

6. CV effects of cocaine: Ischemia Risk of AMI – Acute Myocardial Infarction or Heart Attack increases 24 fold during the 60 minutes following cocaine use There is NO dose-response relationship between cocaine use and AMI Six percent of patients with cocaine-related chest pain have cardiac enzyme elevation Most patients with cocaine-related AMI have no risk factors except concomitant use of tobacco

7. Pathogenesis of cocaine related ischemia

8. What is Ischemia Low blood supply to the bodies organs.

9. Cocaine and atherosclerosis Kollodgie et al, JACC 1991: -Review of 5871 autopsies, 495 subjects with evidence of cocaine use -studied degree of atherosclerosis and mean number of adventitial mast cells per coronary segment -Results: -significantly more mast cells in subjects with cocaine- associated thrombosis than in the other age matched groups -subjects with cocaine-associated thrombosis also had significant coronary atherosclerosis without plaque hemorrhage despite a mean age of 29 +/- 2 years http://www.sciencedirect.com/science/article/pii/073510979190646Q

10. Cocaine and Aortic Dissection Aortic dissection or rupture has been temporally related to cocaine use. Arterial dissection probably results from the substantial increase in systemic arterial pressure induced by cocaine. Also, the cocaine-related rupture of Aortic aneurysm and intracerebral aneurysms has been reported.

11. What do these look like

12. Cocaine Facial Effects If nothing else reaches you Know that cocaine will change your face from the inside. YOU DO NOT HAVE TO LOOK AT THE FOLLOWING SIX SLIDES. PICTURES SHOW THE RESULTS OF USING COCAINE.

13. Danniela Westbrook

14. Cocaine eats away the septum

16. Cocaine eats away the structure of the face

18. Cocaine eats way the sinus cavity.