In this video, Dr Sanjay Gupta, consultant cardiologist, discusses how cocaine use can affect the heart. Cocaine’s main effect is that it increases our sympathetic activity (flight or fight system) by increasing the amount of adrenaline, noradrenaline, dopamine, and serotonin in the blood and therefore causing an exaggerated and prolonged activation of our sympathetic system.

With regard to the heart, cocaine causes an increase in heart rate and blood pressure. Because it has the effect of narrowing the arteries, it can increase the narrowing in the heart arteries. This is also why the blood pressure goes up. What this means is that the user has a horrendous double whammy – the heart is made to ask for more blood and the blood flow is choked at the same time! Imagine trying to press down on the accelerator of your car with all the force that you can and blocking the pipe that takes the fuel to the engine at the same time.

Imagine how damaging that is to the engine and how easily then the engine can break down in that scenario. Another problem with this scenario is that it promotes stagnation of blood and therefore blood clots can form within the vessels which can then make everything worse. In this case, the heart can start suffocating as it does so it can go into funny heart rhythm disturbances which then make everything worse can prove fatal. In addition, cocaine can also interfere directly with the sodium and potassium channels in the heart and cause QT prolongation thereby predisposing patients to dangerous dysrhythmias.