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Clement A, Pezel T, Lequipar A, Guiraud-Chaumeil P, Singh M, Poinsignon H, El Beze N, Gall E, Goncalves T, Lafont A, Henry P, Dillinger JG. [Recreative drug use and cardiovascular disease]. Ann Cardiol Angeiol (Paris) 2023; 72:101638. [PMID: 37738755 DOI: 10.1016/j.ancard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/24/2023]
Abstract
Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.
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Affiliation(s)
- Arthur Clement
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Theo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Paul Guiraud-Chaumeil
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Manveer Singh
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Hugo Poinsignon
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Nathan El Beze
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Trecy Goncalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France.
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Chapman L, Tahir I, Sheriff N, Colwell N. Amphetamine-induced cardiomyopathy complicated by embolic stroke: a case report. Eur Heart J Case Rep 2022; 6:ytac044. [PMID: 35233494 PMCID: PMC8874818 DOI: 10.1093/ehjcr/ytac044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 07/26/2021] [Accepted: 01/26/2022] [Indexed: 12/04/2022]
Abstract
Background Amphetamine use causes cardiomyopathy via catecholamine-mediated effects such
as tachycardia, hypertension, vasoconstriction, and direct cardio-toxic
effects. Traditionally, an increased risk of haemorrhagic stroke is
associated with amphetamine use. However, up to one-third of
stimulant-associated cardiomyopathy patients have left ventricular (LV)
thrombus formation leading to an increased risk of systemic embolization. We
report a case of amphetamine-induced cardiomyopathy complicated by embolic
stroke secondary to LV thrombus. Case summary A 38-year-old man with 6-month history of sustained amphetamine use presented
to the emergency department with left-sided weakness, facial droop, and
dysarthria. Angiography confirmed right middle cerebral artery thrombus.
Prompt mechanical thrombectomy yielded full neurological recovery. Dyspnoea
prompted transthoracic echocardiography showing dilated cardiomyopathy with
an ejection fraction of 5% and LV thrombus. Anticoagulation was
initiated with warfarin as well as pharmacological therapy for heart failure
with reduced ejection fraction including bisoprolol, spironolactone, loop
diuretic, and sacubitril/valsartan. He was discharged successfully following
resolution of ventricular thrombus and medical management of heart failure.
Clinical recovery was hampered by psychosocial factors resulting in
non-adherence to medical therapy and continued amphetamine use. Conclusion Sustained amphetamine use can result in severe dilated cardiomyopathy with LV
thrombus formation and embolic complications such as ischaemic stroke.
Avoidance of amphetamines in conjunction with guideline-directed
pharmacological management are key components of therapy. However,
psychosocial factors can exert significant influence on recovery.
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Affiliation(s)
- Lucy Chapman
- South Tipperary General Hospital, Clonmel, Ireland
| | - Ismail Tahir
- South Tipperary General Hospital, Clonmel, Ireland
| | - Neha Sheriff
- South Tipperary General Hospital, Clonmel, Ireland
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Exposure to Amphetamines Leads to Development of Amphetamine Type Stimulants Associated Cardiomyopathy (ATSAC). Cardiovasc Toxicol 2017; 17:13-24. [PMID: 27663745 DOI: 10.1007/s12012-016-9385-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
With rapidly rising prevalence of exposure to Amphetamine Type Stimulants (ATS), novel insights into cardiotoxic effects of this substance are being presented in the literature and remarkably ATS Associated Cardiomyopathy (ATSAC) is emerging as a novel cardiovascular condition with its distinctive pathogenesis, risk factors, clinical features and prognosis. A comprehensive systematic review was performed to explore and analyze the current evidence on the association between ATS exposure and development of cardiomyopathy, biological mechanisms involved in pathogenesis of ATSAC, risk factors, clinical features and course of patients with ATSAC. Several animal studies, case reports, case series and case-control studies support the association between ATS exposure and ATSAC. Oxidative stress, accelerated apoptosis, increased p53 activity, cardiomyocyte necrosis, perfusion defects, fatty acid toxicity, altered gene expression, abnormal cardiac protein synthesis and function in addition to defects in intracellular calcium hemostasis present themselves as likely mechanisms of cardiotoxicity in ATSAC. Majority of patients with ATSAC were found to be male, young and presented late with severe dilated cardiomyopathy. Female ATS users predominantly develop Takotsubo type of ATSAC and in particular its atypical basal variant. Overall, cessation of ATS exposure seems to be associated with some degree of reversibility and recovery in ATSAC sufferers.
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Leung KP, Qu YH, Qiao DF, Xie WB, Li DR, Xu JT, Wang HJ, Yue X. Critical role of insulin‑like growth factor binding protein‑5 in methamphetamine‑induced apoptosis in cardiomyocytes. Mol Med Rep 2014; 10:2306-12. [PMID: 25230843 PMCID: PMC4214346 DOI: 10.3892/mmr.2014.2572] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 05/14/2014] [Indexed: 11/29/2022] Open
Abstract
Methamphetamine (MA) is a highly abused amphetamine-like psychostimulant. At present, the mechanisms underlying MA-induced cardiotoxicity are poorly understood. The cardiotoxic effects have yet not been clearly elucidated with respect to the apoptotic pathway. Insulin-like growth factor binding protein-5 (IGFBP5) is important for cell growth control and the induction of apoptosis. The aim of the present study was to analyze whether IGFBP5 is involved in MA-induced apoptosis as a novel target. MA-induced apoptosis was observed in neonatal rat ventricular myocytes (NRVMs) in a concentration-dependent manner using a terminal deoxyribonucleotide transferase-mediated dUTP nick end-labeling assay. Using reverse transcription polymerase chain reaction and western blotting, MA was demonstrated to induce concentration-dependent increases in the expression of IGFBP5. Silencing IGFBP5 with small interfering RNA significantly reduced apoptosis and suppressed the expression of caspase-3 in NRVMs following treatment with MA. To the best of our knowledge, the present study provided the first evidence suggesting that IGFBP5 is a potential therapeutic target in MA-induced apoptosis in vitro, providing a foundation for future in vivo studies.
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Affiliation(s)
- Ka-Pui Leung
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Yi-Hong Qu
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Dong-Fang Qiao
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Wei-Bing Xie
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Dong-Ri Li
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Jing-Tao Xu
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Hui-Jun Wang
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Xia Yue
- Department of Forensic Medicine, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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Abstract
An overview of pericarditis, cardiomyopathy, and acute myocarditis is presented. Clinical presentation, causes, physical signs, laboratory testing, and various imaging procedures are discussed. Established pharmacologic and mechanical therapies are reviewed. Short-term and long-term prognoses, when relevant, are discussed.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, 1622 East Lombard Street, Davenport, IA 52803, USA.
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Figueredo VM. Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart. Am J Med 2011; 124:480-8. [PMID: 21605722 DOI: 10.1016/j.amjmed.2010.11.031] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Revised: 11/11/2010] [Accepted: 11/16/2010] [Indexed: 12/20/2022]
Abstract
The heart is a target of injury for many chemical compounds, both medically prescribed and not medically prescribed. Pathophysiologic mechanisms underlying the development of chemical-induced cardiomyopathies vary depending on the inciting agent, including direct toxic effects, neurohormonal activation, altered calcium homeostasis, and oxidative stress. Numerous chemicals and drugs are implicated in cardiomyopathy. This article discusses examples of medication and nonprescribed drug-induced cardiomyopathies and reviews their pathophysiologic mechanisms.
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Affiliation(s)
- Vincent M Figueredo
- Einstein Institute for Heart and Vascular Health, Albert Einstein Medical Center, Jefferson Medical College, Philadelphia, PA, USA.
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Al-Motarreb A, Al-Habori M, Broadley KJ. Khat chewing, cardiovascular diseases and other internal medical problems: the current situation and directions for future research. JOURNAL OF ETHNOPHARMACOLOGY 2010; 132:540-548. [PMID: 20621179 DOI: 10.1016/j.jep.2010.07.001] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Revised: 06/04/2010] [Accepted: 07/01/2010] [Indexed: 05/29/2023]
Abstract
The leaves of khat (Catha edulis Forsk.) are chewed as a social habit for the central stimulant action of their cathinone content. This review summarizes the prevalence of the habit worldwide, the actions, uses, constituents and adverse health effects of khat chewing. There is growing concern about the health hazards of chronic khat chewing and this review concentrates on the adverse effects on health in the peripheral systems of the body, including the cardiovascular system and gastrointestinal tract. Comparisons are made with amphetamine and ecstasy in particular on the detrimental effects on the cardiovascular system. The underlying mechanisms of action of khat and its main constituent, cathinone, on the cardiovascular system are discussed. Links have been proposed between khat chewing and the incidence of myocardial infarction, dilated cardiomyopathy, vascular disease such as hypertension, cerebrovascular ischaemia and thromboembolism, diabetes, sexual dysfunction, duodenal ulcer and hepatitis. The evidence, however, is often based on limited numbers of case reports and only few prospective controlled studies have been undertaken. There is therefore an urgent need for more thorough case-control studies to be performed. This review outlines the current knowledge on the adverse health effects of khat chewing on the cardiovascular system and other internal medical problems, it assesses the evidence and the limitations of the studies and identifies the questions that future studies should address.
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Affiliation(s)
- A Al-Motarreb
- Cardiac Centre, Internal Medicine Department, Sana'a University, Sana'a, Yemen
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Kaye S, Darke S, Duflou J, McKetin R. Methamphetamine-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology. Addiction 2008; 103:1353-60. [PMID: 18855825 DOI: 10.1111/j.1360-0443.2008.02231.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To examine the demographic characteristics, circumstances of death, toxicological results and major organ pathology of methamphetamine-related deaths in Australia. DESIGN Retrospective review of coronial files. SETTING Australia. METHODS Cases in which methamphetamine was listed as a cause of death were identified from the National Coronial Information System (NCIS). FINDINGS A total of 371 cases were identified. The mean age of decedents was 32.7 years; 77% were male and 35% were employed. Route of administration was predominantly by injection (89%). Drugs other than methamphetamine were detected in 89% of cases, most commonly benzodiazepines (41%) and morphine (36%). The median blood methamphetamine concentration was 0.2 mg/l (range 0.02-15.0 mg/l). Deaths were overwhelmingly accidental, with 14% determined to be suicides, and occurred in a private home (71%). Cardiovascular pathology, typically coronary artery atherosclerosis, was detected in 54% of decedents. Cerebrovascular pathology, most commonly cerebral haemorrhage and hypoxia, was present in 20% of cases. CONCLUSIONS Methamphetamine has contributed to a substantial number of deaths in Australia. Users need to be informed of the potential harms of methamphetamine use, particularly those associated with the cardiotoxicity of methamphetamine and the use of methamphetamine in conjunction with other drugs.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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Abstract
AIMS To examine the literature pertaining to the cardiovascular effects of methamphetamine and discuss the implications for methamphetamine users. METHODS Relevant literature was identified through comprehensive MEDLINE and EMBASE searches. FINDINGS AND CONCLUSIONS There is sufficient clinical and experimental evidence to suggest that methamphetamine can have adverse and potentially fatal effects on the cardiovascular system. The existing literature suggests that: (1) methamphetamine users are at elevated risk of cardiac pathology; (2) risk is not likely to be limited to the duration of their methamphetamine use, because of the chronic pathology associated with methamphetamine use; (3) the risk of cardiac pathology is greatest among chronic methamphetamine users; (4) pre-existing cardiac pathology, due to methamphetamine use or other factors, increases the risk of an acute cardiac event; and (5) methamphetamine use is likely to exacerbate the risk of cardiac pathology from other causes, and may therefore lead to premature mortality.
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Affiliation(s)
- Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Australia.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2005. [DOI: 10.1002/pds.1027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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