Q. I have breathlessness and cough when I do not do cocaine. Am I addicted?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by iCliniq medical review team.
Published on Aug 30, 2018 and last reviewed on: Sep 04, 2018

Hello doctor,

I have been taking cocaine once a week for 20 years and on the 1st of last month, I started getting a cough and breathless. It was getting worse when the cocaine wore off. Anyway, I had an ECG which was clear and a 24-hour tape also clear. CT scan on lungs clear. Then I had an ultrasound and came back with mild apical anterior hypokinesis RWMA. The cardiologist said he will see me next month and did not seem bothered. Anyway, I still was doing cocaine and drinking weekends because it is the only time I do not feel breathless but on a Wednesday, when everything is out of my system, I get breathless again and heavy chest. Can you please tell me if I do not do cocaine again, will I get better or am I mucked up for life now?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome to icliniq.com.

Firstly, cocaine has got a wide range of effects on the heart. So, hypokinesia means there is some damage to the heart which may be due to cocaine or may be due to coexistent coronary artery disease. So, you will need coronary angiography preferably, conventional and CT angiography is the alternative.

Also, since hypokinesia is observer dependent, sometimes reported milder hypokinesia may not be actually present and false positive findings are possible. But, we should get it confirmed by further investigations. This much hypokinesia should not cause breathlessness in you, rather it appears to be related to cocaine withdrawal only. Also, I guess you do not have gastric/reflux symptoms.

Cocaine withdrawal symptoms usually settle in a few weeks without treatment. It is better you reduce consumption gradually over the next few weeks, then stop, rather than abruptly stopping.

So, once we rule out heart disease, then you can get back to normal life after quitting its consumption.

Thank you doctor,

I have bad reflux but the breathlessness is constant all the time. It is like I cannot get a deep breath in. Could it be possible I have heart failure or do you think this can get better?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

You should get reflux treated as well as it can cause breathlessness. Acid refluxes into lungs and causes bronchoconstriction which can cause breathlessness. So have antacids, prevent oily, spicy foods, elevate the head-end of the bed during sleep or rest.

Heart failure is of two types, systolic and diastolic. Now, since your ejection fraction is normal, systolic heart failure is unlikely. Regarding diastolic heart, which is possible in you, an echo would show evidence of diastolic dysfunction (usually mentioned in the last part of the report). So, if it is there, then diastolic heart failure is a possibility and you will need diuretics. Even otherwise, there is no harm in having short diuretics trial after your reflux is treated.

After all these, you should get one pulmonary function test done to rule out airway disease which cannot be diagnosed on a CT scan.

Now, in your case, I do think, you may not have true breathlessness, but just a feeling due to withdrawal or may be increased awareness. Do you have increased respiratory rate in one minute (more than 22 to 24 per minute)? Do you get undue breathlessness on running or doing heavy activities or just a usual one? If yes, then it may be a true breathlessness.

Thank you doctor,

I get breathless even when I am sitting down. When I drink alcohol and get drunk, I do not get it but it comes a few days later. I do get a tickly throat and slight chest pain too and then that clears up just to leave me breathless like I cannot get a satisfying breath in. My respiratory doctor said my spirometry is good and my lung function is fine. I am just worried about damaged heart but my cardiologist does not seem bothered with the results. If I lay off the cocaine, is it possible my heart can make a full recovery? If so, how long would it take?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

So I think it is likely related to withdrawal only as drinking or having cocaine will not make breathlessness to subside if it is occurring due to heart failure or any organic cause.

Your heart is not yet damaged to any significant extent. There is just mild apical hypokinesia which is almost equal to normal. So, quitting all will definitely normalize your heart. However, before concluding this, we need to rule out the possibility of disease in coronary arteries. So, I would recommend getiing an angiography either CT or conventional done. If this is normal then nothing to worry.

So overall, it doesn't appear worrisome at present from hearts perspective, but needs some more evaluation of coronary arteries.

Thank you doctor,

I had a CT X-ray of my chest for lungs. Can a cardiologist look at that to see if I have anything?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
#

Hello,

Welcome back to icliniq.com.

Yes, X-ray is a general thing and can be interpreted by any physician including a cardiologist. Also, a CT scan can be interpreted by a cardiologist and he can certainly interpret the printed report which is provided by the radiologist.

However, reporting of the CT scan is best done by a radiologist.

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