Stimulant Drugs of Abuse and Cardiac Arrhythmias

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.

Automated summary

The nonmedical use of prescription and nonprescription drugs is a global epidemic with increasing deaths due to overdose and chronic use. Stimulant drugs, such as cocaine and methamphetamine, have significant effects on the cardiovascular system, including cardiac rhythm. These drugs alter the structure and electrical substrate of the heart, leading to cardiac dysrhythmias. Treatment of cardiac arrhythmias in drug abusers requires a specialized and multidisciplinary approach, due to the unique underlying mechanisms. The use of primary or secondary prevention defibrillators in drug abusers with systolic heart failure is both sensitive and controversial.