Title

Stimulant Drugs of Abuse and Cardiac Arrhythmias

Authors

Paari Dominic, Center of Excellence for Cardiovascular Diseases & Sciences (P.D., H.A., S.B., C.G.K.), Louisiana State University Health Sciences Center, Shreveport.
Javaria Ahmad, Department of Medicine (P.D., J.A., H.A.), Louisiana State University Health Sciences Center, Shreveport.
Hajra Awwab, Center of Excellence for Cardiovascular Diseases & Sciences (P.D., H.A., S.B., C.G.K.), Louisiana State University Health Sciences Center, Shreveport.
Md Shenuarin Bhuiyan, Center of Excellence for Cardiovascular Diseases & Sciences (P.D., H.A., S.B., C.G.K.), Louisiana State University Health Sciences Center, Shreveport.
Christopher G. Kevil, Center of Excellence for Cardiovascular Diseases & Sciences (P.D., H.A., S.B., C.G.K.), Louisiana State University Health Sciences Center, Shreveport.
Nicholas E. Goeders, Department of Pharmacology, Toxicology and Neuroscience (N.E.G., K.S.M.), Louisiana State University Health Sciences Center, Shreveport.
Kevin S. Murnane, Department of Pharmacology, Toxicology and Neuroscience (N.E.G., K.S.M.), Louisiana State University Health Sciences Center, Shreveport.
James C. Patterson, Department of Psychiatry (K.S.M., J.C.P.), Louisiana State University Health Sciences Center, Shreveport.
Kristin E. Sandau, Department of Nursing, Bethel University, St Paul, MN (K.E.S.).
Rakesh Gopinathannair, The Kansas City Heart Rhythm Institute (KCHRI) & Research Foundation, Overland Park Regional Medical Center (R.G.).
Brian Olshansky, University of Iowa Carver College of Medicine, Iowa City (B.O.).

Document Type

Article

Publication Date

1-1-2022

Abstract

Nonmedical use of prescription and nonprescription drugs is a worldwide epidemic, rapidly growing in magnitude with deaths because of overdose and chronic use. A vast majority of these drugs are stimulants that have various effects on the cardiovascular system including the cardiac rhythm. Drugs, like cocaine and methamphetamine, have measured effects on the conduction system and through several direct and indirect pathways, utilizing multiple second messenger systems, change the structural and electrical substrate of the heart, thereby promoting cardiac dysrhythmias. Substituted amphetamines and cocaine affect the expression and activation kinetics of multiple ion channels and calcium signaling proteins resulting in EKG changes, and atrial and ventricular brady and tachyarrhythmias. Preexisting conditions cause substrate changes in the heart, which decrease the threshold for such drug-induced cardiac arrhythmias. The treatment of cardiac arrhythmias in patients who take drugs of abuse may be specialized and will require an understanding of the unique underlying mechanisms and necessitates a multidisciplinary approach. The use of primary or secondary prevention defibrillators in drug abusers with chronic systolic heart failure is both sensitive and controversial. This review provides a broad overview of cardiac arrhythmias associated with stimulant substance abuse and their management.

Publication Source (Journal or Book title)

Circulation. Arrhythmia and electrophysiology

First Page

e010273

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