Center of Excellence for Cardiovascular Diseases & Sciences (P.D., H.A., S.B., C.G.K.), Louisiana State University Health Sciences Center, Shreveport.
Department of Medicine (P.D., J.A., H.A.), Louisiana State University Health Sciences Center, Shreveport.
Circ Arrhythm Electrophysiol. 2022 Jan;15(1):e010273. doi: 10.1161/CIRCEP.121.010273. Epub 2021 Dec 28.
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.
非医疗用途的处方和非处方药物是一种全球性的流行疾病，其规模迅速扩大，因过量使用和慢性使用而导致死亡。这些药物绝大多数是兴奋剂，它们对心血管系统有各种影响，包括心律。可卡因和冰毒等药物对传导系统有直接和间接的作用，通过多种第二信使系统改变心脏的结构和电基质，从而促进心律失常。替代安非他命和可卡因会影响多种离子通道和钙信号蛋白的表达和激活动力学，导致心电图变化以及房性和室性心动过缓和心动过速。先前存在的条件会导致心脏基质发生变化，从而降低药物引起的心律失常的阈值。治疗滥用药物的患者的心律失常可能需要专门的治疗，并需要了解独特的潜在机制，并需要采取多学科方法。在慢性收缩性心力衰竭的滥用药物患者中使用原发性或继发性预防除颤器既敏感又有争议。本综述提供了与兴奋剂物质滥用相关的心律失常及其治疗的广泛概述。
