Cardiac Complications of Common Drugs of Abuse: Pharmacology, Toxicology, and Management

Gagnon, Luke R.; Sadasivan, Chandu; Perera, Kevin; Oudit, Gavin Y.

doi:10.1016/j.cjca.2021.10.008

Cited by 10 publications

(11 citation statements)

References 141 publications

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“…Similarly, Δ 9 -THC-induced tachycardia is related to biphasic and dose-dependent effects, and low or moderate doses cause a direct sympathetic stimulation, leading to tachycardia, hypertension, and increased cardiac output, and a higher dose a Δ 9 -THC-induced parasympathetic vasodilatation with bradycardia and hypotension [ 57 , 106 ]. The autonomic dysregulation results in increased cardiac output and workload, thus increasing the myocardial oxygen demand induced by Δ 9 -THC, coupled with microvascular/coronary artery spasm and the prothrombotic state arising from Δ 9 -THC use, which has been associated with an increased risk of acute coronary syndrome, even in the absence of an atherosclerotic coronary artery disease [ 107 ]. Consequently, the use of cannabis should be cautioned in patients with a high cardiovascular risk profile or affected by cardiovascular diseases and avoided 2 h before physical exercise [ 108 ].…”

Section: Discussionmentioning

confidence: 99%

The Old and the New: Cardiovascular and Respiratory Alterations Induced by Acute JWH-018 Administration Compared to Δ9-THC—A Preclinical Study in Mice

Marchetti

Bilel

Tirri

et al. 2023

IJMS

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Several new psychoactive substances (NPS) are responsible for intoxication involving the cardiovascular and respiratory systems. Among NPS, synthetic cannabinoids (SCs) provoked side effects in humans characterized by tachycardia, arrhythmias, hypertension, breathing difficulty, apnoea, myocardial infarction, and cardiac arrest. Therefore, the present study investigated the cardio-respiratory (MouseOx Plus; EMKA electrocardiogram (ECG) and plethysmography TUNNEL systems) and vascular (BP-2000 systems) effects induced by 1-naphthalenyl (1-pentyl-1H-indol-3-yl)-methanone (JWH-018; 0.3–3–6 mg/kg) and Δ9-tetrahydrocannabinol (Δ9-THC; 0.3–3–6 mg/kg), administered in awake CD-1 male mice. The results showed that higher doses of JWH-018 (3–6 mg/kg) induced deep and long-lasting bradycardia, alternated with bradyarrhythmia, spaced out by sudden episodes of tachyarrhythmias (6 mg/kg), and characterized by ECG electrical parameters changes, sustained bradypnea, and systolic and transient diastolic hypertension. Otherwise, Δ9-THC provoked delayed bradycardia (minor intensity tachyarrhythmias episodes) and bradypnea, also causing a transient and mild hypertensive effect at the tested dose range. These effects were prevented by both treatment with selective CB1 (AM 251, 6 mg/kg) and CB2 (AM 630, 6 mg/kg) receptor antagonists and with the mixture of the antagonists AM 251 and AM 630, even if in a different manner. Cardio-respiratory and vascular symptoms could be induced by peripheral and central CB1 and CB2 receptors stimulation, which could lead to both sympathetic and parasympathetic systems activation. These findings may represent a starting point for necessary future studies aimed at exploring the proper antidotal therapy to be used in SCs-intoxicated patient management.

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Section: Discussionmentioning

confidence: 99%

The Old and the New: Cardiovascular and Respiratory Alterations Induced by Acute JWH-018 Administration Compared to Δ9-THC—A Preclinical Study in Mice

Marchetti

Bilel

Tirri

et al. 2023

IJMS

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“…Stimulant use, especially that of methamphetamine, is increasing with a corresponding rise in adverse health effects 1–4 . It is associated with a myriad of cardiovascular conditions, including cardiomyopathy 5–7 . Patients with stimulant-associated cardiomyopathy (SA-CMP) have high rates of morbidity, mortality, and acute care presentations related to heart failure (HF) 8,9 .…”

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confidence: 99%

A Mixed-methods Evaluation of an Addiction/Cardiology Pilot Clinic With Contingency Management for Patients With Stimulant-associated Cardiomyopathy

et al. 2022

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ObjectivesContingency management (CM) is one of the most effective treatments for stimulant use disorder but has not been leveraged for people with stimulant-associated cardiomyopathy (SA-CMP), a chronic health condition with significant morbidity and mortality. We aimed to determine the feasibility and acceptability of a multidisciplinary addiction/cardiology clinic with CM for patients with SA-CMP and to explore barriers and facilitators to engagement and recovery.MethodsWe recruited patients with a hospitalization in the past 6 months, heart failure with reduced ejection fraction (<40%) and stimulant use disorder to participate in Heart Plus, a 12-week addiction/cardiology clinic with CM in an urban, safety-net, hospital-based cardiology clinic, which took place March 2021 through June 2021. Contingency management entailed gift card rewards for attendance and negative point-of-care urine drug screens. Our mixed-methods study used the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework. We obtained data from the medical record, staff surveys, and qualitative interviews with participants.ResultsThirty-eight patients were referred, 17 scheduled an appointment, and 12 attended the intake appointment and enrolled in the study. Mean treatment duration was 8 of 12 weeks. Of the 9 participants who attended more than one visit, the median attendance was 82% of available visits for in-person visits and 83% for telephone visits, and all patients reported decreased stimulant use.ConclusionsDelivering CM through a multidisciplinary addiction/cardiology clinic for patients with SA-CMP was feasible and engaged patients in care. Further research is needed to assess whether this program is associated with improved heart failure outcomes.

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“…The first step in recognizing this condition is to include questioning regarding AAS misuse when investigating potential causes of a cardiomyopathy. 11 High-risk groups where this is particularly relevant would appear to be young and middle-aged males, especially those involved in bodybuilding or security-related professions. 3 All patients diagnosed with a cardiomyopathy should have a full blood examination performed with haemoglobin and haematocrit, and this is a readily-accessible investigation that may flag the presence of AAS misuse if elevated.…”

Section: Discussionmentioning

confidence: 99%

Anabolic steroid misuse is an important reversible cause of cardiomyopathy: a case report

Milevski

Sawyer

Gerche

et al. 2022

European Heart Journal - Case Reports

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Background Anabolic steroid misuse is very common and has been linked to the development of a severe cardiomyopathy, arrhythmias and sudden death. Case Summary A forty-six year old miner presented to hospital with subacute dyspnoea and palpitations. Investigations revealed atrial fibrillation and a severe dilated cardiomyopathy with left ventricular ejection fraction of 12%. The patient had a history of longstanding exogenous testosterone administration. Haematological investigations demonstrated a marked polycythaemia, with haematocrit of 0.60 L/L (normal 0.40-0.54 L/L). Hormonal investigations revealed an elevated testosterone level of 46.4 nmol/L (normal 8.0–30.0 nmol/L) and suppressed luteinizing and follicle-stimulating hormones, consistent with excess testosterone use. The patient was referred to the endocrinology specialty team for support with ceasing excess testosterone use, while commencing guideline-directed heart failure therapy. At six months’ follow-up, the patient’s left ventricular ejection fraction had normalised and he was asymptomatic. Biochemical indicators of testosterone excess had also normalised. Discussion Anabolic steroids are widely misused, particularly amongst young and middle-aged males. Cardiovascular complications include a potentially reversible severe cardiomyopathy, accelerated coronary disease, dyslipidaemia, arrhythmias and sudden death. It is important to identify a history of anabolic steroid misuse when investigating cardiomyopathy and be alert for indicators such as polycythaemia. Cessation of anabolic steroid missuse may lead to complete reversal of cardiomyopathy but should be undertaken in close partnership with the patient and endocrinologists.

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Cardiac Complications of Common Drugs of Abuse: Pharmacology, Toxicology, and Management

Cited by 10 publications

References 141 publications

The Old and the New: Cardiovascular and Respiratory Alterations Induced by Acute JWH-018 Administration Compared to Δ9-THC—A Preclinical Study in Mice

The Old and the New: Cardiovascular and Respiratory Alterations Induced by Acute JWH-018 Administration Compared to Δ9-THC—A Preclinical Study in Mice

A Mixed-methods Evaluation of an Addiction/Cardiology Pilot Clinic With Contingency Management for Patients With Stimulant-associated Cardiomyopathy

Anabolic steroid misuse is an important reversible cause of cardiomyopathy: a case report

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