Photo: Heart before and after prolonged use of cocaine, causing endocartis.
The combination of alcohol and cocaine has more side effects than either substance alone. Cocaine produces a high while alcohol pulls down as a depressant, one substance can intensify and amplify the high of the other substance, and each can mitigate symptoms of the other. The combination can result in behavioral changes not seen with either alone. But abuse of the two has also been associated with significantly more cardiac emergencies including heart attacks. One reason is cocaethylene, or ethylbenzoylecgonine, a byproduct of alcohol and cocaine in the liver (1).
What cocaine does to your heart
The purification of powdered cocaine, or cocaine hydrochloride occurred over 100 years ago. It was used in tonics and elixirs and to snort or inhale. By the 1980’s this fine, white, powder form was cooked into a smokable freebase form called “crack” (2). Short-term effects of cocaine use include constricted blood vessels; and increased body temperature, heart rate, and blood pressure (3). Taken to an extreme, these seemingly mild symptoms may result in more complicated issues. Cocaine is associated with a number of cardiovascular diseases, including heart attacks, cardiomyopathies, arrhythmias, aortic dissection, and endocarditis. As cocaine is metabolized in the liver, one of the primary byproducts is benzoylecgonine, directly related to the ethylbenzolecgonine or cocaethylene, produced when alcohol and cocaine are combined (4).
What cocaethylene does to your heart
Once cocaethylene forms, it affects your normal heart function in two crucial ways. First, its presence slows the breakdown rate of cocaine and cocaine continues to circulate in your bloodstream. This can increase your heart rate 200% more than cocaine would do on its own. In addition, cocaethylene interferes with your heart’s ability to contract and pump normally. The rise in heart rate increases the likelihood that you will experience a heart attack, while the change in heart contractions increases the odds that you will ultimately develop heart failure. Further, cocaethylene has been associated with seizures, liver damage, and compromised functioning of the immune system (5).