Cardiac Complaints Encountered After Use of Street Drugs: A Review of their Cardiac Toxicity Mechanism
DOI:
https://doi.org/10.17140/EMOJ-3-130Keywords:
Street drug, Marijuana abuse, Atrioventricular block, Unstable anginaAbstract
Objectives: The upward trend leading to versatility in street drug (SD) usage paves the way to numerous complications to organ systems, including cardiovascular events. But, findings on cardiac complications, as well as their prevalence and survey from SD abusers are not encountered in the literature.
Material and Methods: In this survey study, patients admitted to the emergency department (ED) with suspected substance abuse were collected prospectively and cardiac complications were observed. The relationship between variables and all types of SDs were analyzed. Prevalance of the cardiovascular events were calculated. Also, uncommon cardiovascular events after SD use were defined.
Results: In a total of 425 (424 male, 98.4%) participants, cardiac complaints after substance use were noted in 14.6% (n=62). High degree AV-node conduction block secondary to synthetic cannabis, and moreover occlusive ST segment elevated myocardial infarction (STEMI) after cannabis use was identified. In other 2 cases, ecstasy use was associated with both STEMI and tachycardia.
Conclusion: Emergency physicians and cardiologist must be competent in the management of patients with substance abuse and potential novel cardiac complications. Especially young males with substance use and suspicious presentations such as syncope, palpitation, and vomiting complaints may be at risk. Cardiac complications on rhythm disturbance, conduction delay or obstructive myocardial infarct can become other than in literature.
References
2013 Annual Report of the American Association of Poison Control Centre’s National Poison Data System (NPDS): 31st Annual Report. Clin Toxicol. 2014; 52(10): 1032-1283. doi: 10.3109/15563650.2014.987397
Seely KA, Lapoint J, Moran JH, Fattore L. Spice drugs are more than harmless Herbal Blends: A review of the pharma-cology and toxicology of synthetic cannabinoid. Prog Neuro-psychopharmacol Biol Psychiatry. 2012; 39(2): 234-243. doi: 10.1016/j.pnpbp.2012.04.017
Rosenbaum CD, Carreiro SP, Babu KM. Here today, gone tomorrow…and back again? A review of herbal marijuana al-ternatives (K2, Spice), synthetic cathinones (bath salts), kratom, Salvia divinorum, methoxetamine, and piperazines. J Med Toxi-col. 2012; 8(1): 15-32. doi: 10.1007/s13181-011-0202-2
Wells DL, Ott CA. The “new” marijuana. Ann Pharmacother 2011; 45(3): 414-417.
Thomas G, Kloner RA, Rezkalla S. Adverse Cardiovascular, Cerebrovascular, and Peripheral Vascular Effects of Marijuana Inhalation: What Cardiologists Need to Know. Am J Cardiol. 2014; 113(1): 187-190. doi: 10.1016/j.amjcard.2013.09.042
Haney M. The marijuana withdrawal syndrome: diagnosis and treatment. Curr Psychiatry Rep. 2005; 7(5): 360-366. Web site. https://www.ncbi.nlm.nih.gov/pubmed/16216154. Accessed: November 21st, 2016
Auwarter V, Dresen S, Weinmann W, Muller M, Putz M, Fer-reiros N. ‘Spice’ and other herbal blends: harmless incense or cannabinoid designer drugs? J Mass Spectrom. 2009;44(5): 832- 837. doi: 10.1002/jms.1558
Defer N, Wan J, Souktani R. The cannabinoid receptor type 2 promotes cardiac myocyte and fibroblast survival and protects against ischemia/reperfusion-induced cardiomyopathy. FASEB J. 2009; 23(7): 2120-2130. doi: 10.1096/fj.09-129478
Beuselinck B, Willems R. Think outside the heart! Case re-port of Lyme. Acta Cardiol. 2007; 62(5): 519-522. doi: 10.2143/ AC.62.5.2023418
Akins D, Awdeh MR. “Marijuana and second-degree AV block.” South Med J. 1981; 74(3): 371-373. Web site. https:// www.ncbi.nlm.nih.gov/pubmed/6261403. Accessed November 21, 2016
Wessler JD, Stant J, Duru S, Rabbani L, Kirtane AJ. Updates to the ACCF/AHA and ESC STEMI and NSTEMI guidelines: Putting guidelines into clinical practice. Am J Cardiol. 2015; 115(5): 23-28. doi: 10.1016/j.amjcard.2015.01.004
Mukamal KJ, Maclure M, Muller JE, Mittleman MA. An ex-ploratory prospective study of marijuana use and mortality fol-lowing acute myocardial infarction. Am Heart J. 2008; 155(3): 465-470. doi: 10.1016/j.ahj.2007.10.049
Perrine SA, Michaels MS, Ghoddoussi F, Hyde EM, Tancer ME, Galloway MP. Cardiac effects of MDMA on the metabolic profile determined with 1H-magnetic resonance spectroscopy in the Rat. NMR Biomed. 2009; 22(4): 419-425. doi: 10.1002/ nbm.1352
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