heroin and Heart-Valve-Diseases

Injection drug users (IDUs) develop more right-sided infective endocarditis (IE) than non-IDUs, but it is not known whether this risk is specific to any particular injected drug. This study reviews the clinical characteristics of IE in an urban population and examines the association of drug type with manifestations of IE.. A retrospective cohort of 247 cases of IE was analyzed. Demographic, clinical, microbiologic, and echocardiographic data were collected.. Our cohort featured a 74% IDU rate, most with heroin. Staphylococcus aureus was the most prevalent organism. S. aureus IE was more likely to occur in IDUs versus non-IDUs (OR 5.5, p<0.0001). Enterococcus faecalis IE was less likely to occur in IDUs (OR 0.21, p=0.02). Tricuspid valve (TV) IE was more likely to occur in IDUs (OR 4.37, p=0.001), while mitral valve (MV) IE occurred less commonly in IDUs (OR 0.40, p=0.005). TV IE occurred more frequently in heroin users vs. IDUs not using heroin (OR 4.03, p=0.033).. The epidemiology of IE in this cohort is different from that reported recently in other cohorts, likely due to the high prevalence of IDU. Heroin use may underlie the association between IDU and right-sided endocarditis.

Topics: Endocarditis; Endocarditis, Bacterial; Female; Heart Valve Diseases; Heroin; Hospitals, Urban; Humans; Male; Retrospective Studies; Staphylococcal Infections; Staphylococcus aureus; Substance Abuse, Intravenous

We performed screening two-dimensional and M-mode echocardiograms on 23 pregnant intravenous drug abusers who had systolic murmurs that clinically appeared physiologic. Although no patient had symptoms or a history of cardiac disease, all but two of the women were evaluated as having unexpected cardiac valvular changes. The majority of morphologic valvular findings on echocardiography consisted of either a mitral valve prolapse or valvular leaflet thickening. However, two of these 21 women were identified as having a previously undiagnosed aortic or tricuspid vegetation for which they subsequently received prophylactic antibiotic therapy during labor and delivery. Notably, two additional women among the group with morphologic valvular changes ultimately developed subacute bacterial endocarditis. Atypically, the clinical illness occurred antenatally for one of the two women with a mitral valve prolapse and 18 months postpartum for another women with unexplained valvular thickening. On the basis of these observations, a more liberal use of echocardiography in the care of the pregnant intravenous drug abuser population is suggested for evaluation of otherwise seemingly innocuous systolic murmurs.

Topics: Adult; Cocaine; Echocardiography; Endocarditis, Subacute Bacterial; Female; Heart Auscultation; Heart Murmurs; Heart Valve Diseases; Heroin; Humans; Mitral Valve Prolapse; Pregnancy; Pregnancy Complications, Cardiovascular; Risk Factors; Substance Abuse, Intravenous; Tricuspid Valve Insufficiency

Topics: Adult; Bronchography; Drug-Related Side Effects and Adverse Reactions; Granuloma; Heart Valve Diseases; Heroin; Heroin Dependence; Humans; Hypertension, Pulmonary; Injections, Intravenous; Lung; Lung Diseases; Male; Narcotics; Pulmonary Edema; Respiratory Tract Infections; Sepsis; Substance-Related Disorders; Syringes; Talc; Tricuspid Valve; Tuberculosis, Pulmonary

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