Characteristic Cardiac Magnetic Resonance (CMR) Imaging Findings of Cocaine-Induced Myocardial Injury.

Cocaine is a widely available illicit substance with a costly financial and social burden on the healthcare infrastructure. Both acute and chronic cocaine use can lead to sequelae of cardiac diseases, including myocardial infarction, aortic dissection, and cardiomyopathy. Cardiac magnetic resonance (CMR) imaging is a powerful tool for detecting myocardial injury leading to prompt treatment and risk stratification. We present two differing cases of sequelae of myocardial injury as a result of cocaine use. We present critical findings on CMR imaging, including myocardial injury patterns, which can help differentiate between acute and chronic injury and assess the extent of damage. Cocaine exerts potent sympathomimetic effects, increasing myocardial oxygen demand and causing coronary vasospasm, thrombosis, and direct myocyte toxicity. Acute cocaine use significantly elevates the risk of myocardial infarction, while chronic use can lead to cardiomyopathy and heart failure. CMR features include wall motion abnormalities, myocardial perfusion defects, and fibrosis. Early identification and intervention can potentially reverse interstitial fibrosis before progression to irreversible damage. CMR is an essential diagnostic tool for characterizing myocardial injury, distinguishing between reversible and irreversible damage, and providing prognostic information on cocaine-induced myocardial injury. The cases highlight the importance of CMR in managing and understanding the full spectrum of cocaine-related cardiac damage.