Does breathlessness and a cough indicate cocaine addiction?

Question

Hello doctor,

I have been using cocaine once a week for 20 years. On the first of last month, I started developing a cough and feeling breathless, with the symptoms worsening when the effects of the cocaine wore off. I had an ECG, which came back clear, and a 24-hour monitor, which was also clear. A CT scan of my lungs showed nothing. Then I had an ultrasound, which revealed mild apical anterior hypokinesis and RWMA. The cardiologist said he would see me next month and did not seem too concerned.

Despite this, I continued using cocaine and drinking on weekends because it was the only time I did not feel breathless. However, by the next day, when the substances have left my system, I get breathless again with a heavy chest. Can you please tell me if I stop using cocaine, will I get better, or have I damaged my body permanently?

Answer 1

Hello,

Welcome to icliniq.com.

Firstly, cocaine has a wide range of effects on the heart. Hypokinesia indicates some damage to the heart, which may be caused by cocaine or may result from coexistent coronary artery disease. Therefore, you will need coronary angiography, preferably conventional, with CT (computed tomography) angiography as an alternative. Additionally, since hypokinesia is observer-dependent, milder cases of hypokinesia that are reported may not actually be present, and false-positive findings are possible. However, we should confirm this with further investigations. The degree of hypokinesia observed should not be causing your breathlessness; it seems more likely to be related to cocaine withdrawal.

Also, I assume you do not have any gastric or reflux symptoms. Cocaine withdrawal symptoms typically resolve within a few weeks without treatment. It is better to reduce consumption gradually over the next few weeks before stopping completely, rather than quitting abruptly. Once we rule out heart disease, you should be able to return to a normal life after quitting cocaine use.

Regards.

Answer 2

Hello,

Welcome back to icliniq.com.

You should get your reflux treated, as it can cause breathlessness. Acid reflux can enter the lungs and lead to bronchoconstriction, which can result in breathlessness. To manage this, take antacids, avoid oily and spicy foods, and elevate the head of your bed while sleeping or resting.

Heart failure comes in two types: systolic and diastolic. Since your ejection fraction is normal, systolic heart failure is unlikely. Regarding diastolic heart failure, which is a possibility in your case, an echocardiogram would show evidence of diastolic dysfunction (usually mentioned in the last part of the report). If present, diastolic heart failure is a possibility, and you may need diuretics. Even if diastolic dysfunction is not present, there is no harm in trying a short course of diuretics after your reflux is treated.

After addressing the reflux, you should also have a pulmonary function test to rule out any airway disease, as this cannot be diagnosed through a CT (computed tomography) scan.

In your case, I believe the breathlessness may not be genuine but rather a sensation related to withdrawal or heightened awareness. Do you notice an increased respiratory rate (more than 22-24 breaths per minute) at rest? Do you experience undue breathlessness when running or doing heavy activities, or is it just the usual kind? If yes, then it may be true breathlessness.

Regards.

Answer 3

Hello,

Welcome back to icliniq.com.

I believe it is likely related to withdrawal, as drinking alcohol or using cocaine would not relieve breathlessness if it were caused by heart failure or any other organic condition. Your heart has not been damaged to any significant extent. There is only mild apical hypokinesia, which is nearly normal. So, quitting all of these substances should definitely help normalize your heart function. However, before making that conclusion, we need to rule out the possibility of coronary artery disease. I would recommend having an angiogram, either CT or conventional. If the results are normal, there is nothing to worry about. Overall, it does not appear to be worrisome from a heart perspective, but further evaluation of the coronary arteries is needed.

Regards.

Answer 4

Hello,

Welcome back to icliniq.com.

Yes, an X-ray is a general test and can be interpreted by any physician, including a cardiologist. A cardiologist can also review a CT scan and interpret the printed report provided by the radiologist. However, the interpretation of the CT scan itself is best done by a radiologist.

Regards.