Cardiac MRI may detect acute and chronic effect of cocaine on cardiovascular system

Magnetic Resonance Imaging of heart or Cardiac MRI may detect cocaine’s effects on the cardiovascular system and help differentiate between acute and chronic conditions, revealed a study published in the journal Radiology: Cardiothoracic Imaging.

Prof. Francone from Sapienza University in Rome and colleagues recently conducted a review of existing literature on the use of cardiac Magnetic Resonance Imaging, MRI in cocaine abuse evaluation which showed a pivotal role of cardiac MRI in determining cocaine-related heart risks.

Cardiac MRI’s ability to distinguish between the different cardiac manifestations of cocaine abuse is important because they all have different patterns,” Prof. Francone said. “Even though all these pathologies have cocaine abuse as the primary cause, the myocardial damage and, therefore, clinical course are completely different, ranging from complete recovery to heart failure.”

Cocaine abuse is a significant public health problem around the world. In the European Union alone, the prevalence of cocaine consumption was estimated to be around 3.4 million among people ages 15 to 64 years in 2017, 

The abuse of cocaine can have particularly devastating effects on the heart. These effects can be both acute, with severe and sudden onset attacks, and chronic, developing and worsening over the years. Examples of cocaine’s acute effects include heart attacks, and acute myocarditis, or inflammation of the heart muscle. A common chronic effect is a cardiomyopathy, a condition in which the heart muscle becomes enlarged, thick or rigid.

Being able to distinguish between these conditions is vital for proper interventions, yet in many cases, diagnosis is difficult due to overlapping symptoms. Typically, a thorough diagnostic workup is necessary, featuring clinical history, laboratory tests, an electrocardiogram, or EKG, stress test, non-invasive imaging modalities, and coronary angiography.

As a non-invasive imaging method, cardiac Magnetic Resonance Imaging,MRI is well positioned to be central to the diagnostic workup of cocaine abuse-related heart problems. Its greatest strength, according to study senior author Marco Francone, M.D., Ph.D., from Sapienza University in Rome, is its ability to provide a microscopic view into living tissue, helping clinicians differentiate among a wide spectrum of heart diseases.

This is a unique feature of cardiac Magnetic Resonance Imaging, MRI which sets it apart from other imaging modalities and places it in a pivotal role in the management of substance abuse patients and, generally speaking, of structural heart diseases,” he said.

The research showed that cardiac Magnetic Resonance Imaging, MRI can detect cocaine’s effects on the cardiovascular system and help differentiate between acute and chronic conditions.

“Cardiac MRI’s ability to distinguish between the different cardiac manifestations of cocaine abuse is important because they all have different patterns,” Prof. Francone said. “Even though all these pathologies have cocaine abuse as primary cause, the myocardial damage and, therefore, clinical course are completely different, ranging from complete recovery to heart failure.”

What is MRI of the heart?

Magnetic resonance imaging (MRI) is a test that uses a large magnet, radio signals, and a computer to make images of organs and tissue in the body. In this case, the heart is imaged.

The MRI machine is large and tube-shaped. It creates a strong magnetic field around the body. Some MRI machines are more open.

The magnetic field lines up the hydrogen protons in your body. The radio waves then knock the protons out of position. As they realign back into proper position, they send out radio signals. A computer receives the signals and converts them into images of the body. This image appears on a viewing monitor.

Why might I need an MRI of the heart?

MRI of the heart may be done to assess signs or symptoms that may suggest:

• Atherosclerosis. This is a gradual clogging of the arteries by fatty materials and other substances in the blood stream. It develops over many years.
• Cardiomyopathy. This happens when the heart muscle becomes thick and weakened.
• Congenital heart disease. These are defects in the heart that happen as the fetus forms. An example is a hole in the wall between the two lower chambers of the heart (ventricular septal defect).
• Heart failure. This condition means the heart muscle is weak and can’t pump enough blood to the body.
• Aneurysm. This is a widening and weakening of a part of the heart muscle or the aorta.
• Heart valve disease. When heart valves become damaged, it can block blood flow in the heart.
• Cardiac tumor. A tumor of the heart may happen on the outside surface or inside the heart.

There may be other reasons for your healthcare provider to recommend an MRI of the heart.

What are the risks of a MRI of the heart?

There is no radiation exposure during MRI.

You can’t have an MRI if you have a:

• Pacemaker
• Older intracranial aneurysm clips
• Cochlear implants
• Certain prosthetic devices (such as artificial joint)
• Implanted medicine infusion pump
• Neurostimulator
• Bone growth stimulator
• Certain intrauterine contraceptives (IUDs)
• Other iron-based metal implants
• Bullet or shrapnel

If you are pregnant or think you may be, tell your healthcare provider. MRI is generally safe in pregnancy, but you and your healthcare provider should discuss the risks and benefits of having MRI.

If contrast dye is used, there is a risk you could have an allergic reaction to the dye. If you are allergic to or sensitive to medicines, tell your healthcare provider. If you have kidney problems, there is a risk of a serious reaction to the dye. Discuss this risk with your healthcare provider prior to the test.

MRI contrast may have an effect on other conditions, such as allergies, asthma, anemia, low blood pressure, kidney disease, and sickle cell disease.

Nephrogenic systemic fibrosis (NSF) is a very rare but serious complication of MRI contrast use in people with kidney disease or kidney failure. If you have a history of kidney disease, kidney failure, kidney transplant, liver disease or are on dialysis, inform the MRI technologist or radiologist prior to receiving contrast.

There may be other risks depending on your specific medical condition. Be sure to discuss any concerns with your healthcare provider prior to the MRI.