heroin and Heart-Failure

Topics: Adult; Aged; Analysis of Variance; Child, Preschool; Chronic Disease; Double-Blind Method; Dyspnea; Exercise; Exercise Test; Female; Heart Failure; Heroin; Humans; Male; Middle Aged; Narcotics; Prospective Studies; Regression Analysis

Cardiovascular disease (CVD) and heart failure (HF) are major causes of mortality in low-income populations and differ by sex. Risk assessment that incorporates cardiac biomarkers is common. However, research evaluating the utility of biomarkers rarely includes controlled substances, which may influence biomarker levels and thus influence CVD risk assessment.. We identified the effects of multiple substances on soluble "suppression of tumorigenicity 2" (sST2), a biomarker of adverse cardiac remodelling, in 245 low-income women. Adjusting for CVD risk factors, we examined associations between substance use and sST2 over six monthly visits.. Median age was 53 years and 74% of participants were ethnic minority women. An sST2 level > 35 ng/mL (suggesting cardiac remodelling) during ≥1 study visit was observed in 44% of participants. In adjusted analysis, higher sST2 levels were significantly and positively associated with the presence of cocaine (Adjusted Linear Effect [ALE]:1.10; 95% CI:1.03-1.19), alcohol (ALE:1.10; 95% CI:1.04-1.17), heroin (ALE:1.25; 95% CI:1.10-1.43), and the interaction between heroin and fentanyl use.. Results suggest that the use of multiple substances influences the level of sST2, a biomarker often used to evaluate cardiovascular risk. Incorporating substance use alongside cardiac biomarkers may improve CVD risk assessment in vulnerable women.

Topics: Biomarkers; Cardiovascular Diseases; Ethnicity; Female; Heart Failure; Heroin; Humans; Interleukin-1 Receptor-Like 1 Protein; Middle Aged; Minority Groups; Prognosis; Substance-Related Disorders; Ventricular Remodeling

Topics: Adult; Electrocardiography; Fatal Outcome; Heart Failure; Heroin; Heroin Dependence; Humans; Male; Myocardial Infarction; Substance Withdrawal Syndrome

The haemodynamic effects of intravenous cyclizine, an antiemetic that is widely given with opioids in left ventricular failure and myocardial infarction, were studied in 11 patients with severe heart failure. Cyclizine significantly increased systemic and pulmonary arterial pressures, and right and left ventricular filling pressures, and negated the venodilatory effects of diamorphine. The use of cyclizine in patients with heart failure should, therefore, be avoided.

Topics: Adult; Aged; Blood Pressure; Cyclizine; Female; Heart Failure; Heart Rate; Hemodynamics; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; Myocardial Infarction; Pulmonary Wedge Pressure

An 18-year-old man developed acute pulmonary edema following heroin overdose. Two days after initial improvement, there was recurrence of hypotension and pulmonary edema with severe hypoxemia refractory to mechanical ventilatory support utilizing positive and end-expiratory pressure. Cardiac catheterization revealed elevated pulmonary capillary wedge pressure suggestive of left ventricular failure. The use of digitalis and diuretics resulted in prompt clinical improvement and ultimate recovery. Evidence is presented indicating that this patient represents an uncommon but important syndrome of acute cardiomyopathy with left ventricular failure which complicates the clinical course of certain cases of heroin overdose. Its physiologic diagnosis is of obvious importance in the choice of proper therapy, thereby increasing the patient's chances of recovery.

Topics: Acute Disease; Adolescent; Heart Diseases; Heart Failure; Heroin; Heroin Dependence; Humans; Hypotension; Male; Pulmonary Edema; Recurrence

Topics: Adult; Candida; Candidiasis; Endocarditis, Bacterial; Female; Haemophilus Infections; Haemophilus influenzae; Heart Failure; Heroin; Heroin Dependence; Humans; Male; Neurologic Manifestations; Panophthalmitis; Skin Manifestations; Splenomegaly; Staphylococcal Infections; Staphylococcus; Streptococcal Infections; Streptococcus; Substance-Related Disorders

Topics: Antihypertensive Agents; Bloodletting; Bronchodilator Agents; Digitalis; Digoxin; Furosemide; Heart Failure; Heroin; Hospitalization; Humans; Intensive Care Units; Mitral Valve Insufficiency; Mitral Valve Stenosis; Morphine; Oxygen Inhalation Therapy; Phytotherapy; Plants, Medicinal; Plants, Toxic; Positive-Pressure Respiration; Posture; Pulmonary Edema; Respiration, Artificial; Tourniquets; Venous Pressure

Topics: Adult; Arm; Heart Atria; Heart Failure; Heroin; Humans; Injections, Intravenous; Phonocardiography; Substance-Related Disorders; Thrombophlebitis; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Animals; Cardiac Catheterization; Digoxin; Dogs; Heart Failure; Heart Valve Diseases; Heart Valve Prosthesis; Heroin; Humans; Injections, Intravenous; Male; Postoperative Complications; Pseudomonas Infections; Self Medication; Staphylococcal Infections; Substance-Related Disorders; Tricuspid Valve; Tricuspid Valve Insufficiency; Venous Pressure

Topics: Altitude; Brain Injuries; Central Nervous System Diseases; Heart Failure; Heroin; Humans; Hypoxia; Pulmonary Edema; Shock; Substance-Related Disorders

Topics: Acute Disease; Adolescent; Adult; Chemical and Drug Induced Liver Injury; Duodenal Ulcer; Female; Heart Failure; Heroin; Humans; Jaundice; Male; Maryland; Middle Aged; Neurotic Disorders; Pneumonia; Pulmonary Edema; Pulmonary Fibrosis; Radiography; Sarcoidosis; Substance-Related Disorders; Tetanus