heroin and Myocardial-Infarction

The recreational use of illicit drugs remains an enormous and growing problem throughout the United States of America and around the world. Cocaine is most frequently thought of when considering the cardiovascular toxicity of illicit drugs. The association of cocaine use with sudden death due to myocardial ischaemia and infarction is well recognised, and this risk appears to be amplified by concomitant cigarette smoking and alcohol consumption. Like cocaine, amphetamine and its derivatives lead to indirect stimulation of the autonomic nervous system through the release of norepinephrine, dopamine, and serotonin in nerve terminals of the central and autonomic nervous systems. However, amphetamine lacks the ion channel-blocking properties of cocaine. Also similar to cocaine, coronary artery spasm may be induced in individuals with or without atherosclerotic disease and may lead to myocardial infarction. With the movement across the United States of America to legalise marijuana, or cannabis, for medicinal and recreational purposes, it is important to consider its potential deleterious effects. Marijuana has long been thought to have very few adverse effects with the exception of long-term dependence. There are, however, scattered reports of acute adverse events up to and including sudden death. These appear to be due to myocardial infarction. In conclusion, the incidence of sudden death associated with the use of these drugs varies from rare in the case of marijuana use to not infrequent with some drugs such as cocaine. It is important for care providers to recognise the potential for drug abuse when caring for a sudden cardiac arrest survivor.

Topics: Adolescent; Alcohol Drinking; Amphetamines; Cannabis; Cocaine; Death, Sudden, Cardiac; Heroin; Humans; Illicit Drugs; Myocardial Infarction; Smoking; Substance-Related Disorders

A short cut review was carried out to establish whether morphine is better than diamorphine at allieviating chest pain after an acute myocardial infarction. Altogether 66 papers were found using the reported search, of which one presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of this best paper are tabulated. A clinical bottom line is stated.

Topics: Analgesics, Opioid; Emergencies; Evidence-Based Medicine; Heroin; Humans; Male; Middle Aged; Morphine; Myocardial Infarction

Topics: Analgesia; Analgesics; Animals; Blood Pressure; Cyclizine; Heart Arrest; Heroin; Humans; Injections, Intravenous; Methadone; Morphine; Myocardial Infarction; Nausea; Pain; Pentazocine; Pulmonary Circulation; Respiration; Shock, Cardiogenic; Spirometry; Vomiting

A total of 141 patients admitted to hospital with a diagnosis of suspected myocardial infarction were randomized to treatment with intravenous diamorphine (71) or nalbuphine (70). Myocardial infarction was subsequently confirmed in 109 patients. Both drugs provided good analgesia. Heart rate, blood pressure, respiratory rate, peak flow and minute volume were measured over a three-hour study period. Except for a slight fall in systolic blood pressure in the nalbuphine-treated group, there were no statistically significant differences between the groups. The nalbuphine-treated group had higher levels of aspartate aminotransferase and hydroxybutyric acid dehydrogenase but not creatine phosphokinase. The haemodynamic outcome and mortality at three months of the two groups were similar. It is concluded that nalbuphine provides effective analgesia coupled with few adverse circulatory or respiratory effects.

Topics: Analgesics; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Heroin; Humans; Male; Middle Aged; Morphinans; Myocardial Infarction; Nalbuphine; Prospective Studies; Random Allocation; Respiration

One hundred and seventy-six consecutive patients with moderate or severe pain of suspected myocardial infarction were randomized to receive nalbuphine less than or equal to 20 mg or diamorphine less than or equal to 5 mg intravenously with metoclopramide 10 mg and were observed over 2 hours. One hundred and forty-two patients (81%) received the test drug outside hospital. The median time from symptom onset to treatment was 135 minutes for the nalbuphine group and 125 minutes for the diamorphine group. Satisfactory pain relief (grade 0 or 1) was similar for both groups at each time assessment. In particular, within 10 minutes of the drug's administration 77% of those receiving nalbuphine and 68% who received diamorphine had satisfactory pain relief. The number of doses of each drug, the number of patients withdrawn from the trial because of unsatisfactory pain relief or recurrence of chest pain were similar for both groups. For those with myocardial infarction there was similar satisfactory pain relief with nalbuphine as diamorphine. No significant deleterious haemodynamic effects or other side-effects occurred. The noncontrolled classification and low addiction potential of nalbuphine allow for its more widespread use in the control of pain of suspected myocardial infarction.

Topics: Adult; Aged; Drug Evaluation; Female; Heroin; Humans; Injections, Intravenous; Male; Middle Aged; Morphinans; Myocardial Infarction; Nalbuphine; Random Allocation

Narcotic analgesics are the mainstay of pain control in patients with cancer. A controversy has been raging in the United States and Canada as to the legalization of heroin. We have reviewed the literature in order to determine the relative efficacy of heroin and morphine in cancer pain. We applied the following methodologic criteria: Was the assignment of patients to the different opiates randomized? Were all clinically relevant outcomes reported? Were the patients recognizable? Were both clinical and statistical significance considered? Was the opiate regimen feasible in routine clinical practice? Were all patients who entered the study accounted for at its conclusion? Two trials satisfied our first standard. The first, a double-blind cross-over trial, failed to meet standard 4 (the negative conclusion may represent a type 2 error) and only 21% of patients completed both treatment periods. The second study, which compared intramuscular heroin and morphine among patients with postoperative pain, failed to meet standards 3 (patients not described in sufficient detail and only tangentially related to chronic cancer pain) and 4 (type 2 error). Thus the relative efficacy of heroin and morphine in the relief of chronic cancer pain remains unknown. Randomized trials that meet all six methodologic standards must therefore be carried out for this controversy to be resolved.

Topics: Clinical Trials as Topic; Female; Heroin; Humans; Infant, Newborn; Male; Morphine; Myocardial Infarction; Neoplasms; Palliative Care; Random Allocation

Buprenorphine, a new powerful analgesic agent, was used to treat chest pain in patients with suspected myocardial infarction. Initial studies showed no significant changes in systemic or pulmonary artery blood pressure or in heart rate after intravenous buprenorphine. Sublingual buprenorphine also appeared effective in relieving pain, but its onset of action was considerably delayed compared with the intravenous route. A randomised double-blind controlled trial of equivalent doses of buprenorphine and diamorphine showed no significant difference between the drugs in terms of pain relief and duration of action. The occurrence of nausea, vomiting, and other side effects was similar in the two groups. The onset of action of buprenorphine was slightly but significantly slower than that of diamorphine. Since buprenorphine seems to be comparable with diamorphine in action and is not a controlled drug, it may prove useful in both general and hospital practice.

Topics: Buprenorphine; Clinical Trials as Topic; Double-Blind Method; Female; Hemodynamics; Heroin; Humans; Male; Middle Aged; Morphinans; Myocardial Infarction; Random Allocation

Topics: Administration, Oral; Arrhythmias, Cardiac; Clinical Trials as Topic; Disopyramide; Drug Therapy, Combination; Heroin; Humans; Injections, Intravenous; Myocardial Infarction; Prochlorperazine; Pyridines

Topics: Acute Disease; Adult; Aged; Blood Pressure; Clinical Trials as Topic; Female; Heart Rate; Heroin; Humans; Injections, Intravenous; Male; Methadone; Middle Aged; Morphine; Myocardial Infarction; Pain; Pentazocine; Respiration

Topics: Heroin; Heroin Dependence; Humans; Myocardial Infarction; Substance Abuse, Intravenous

Cocaine-related myocardial infarction is a well-known phenomenon. Concurrent heroin use can mask signs and symptoms of myocardial infarction. We discuss an unusual presentation of myocardial infarction, associated with both cocaine and heroin ("speedball") self-injection, that initially went undiagnosed.

Topics: Adult; Cocaine-Related Disorders; Drug Combinations; Heroin; Humans; Male; Myocardial Infarction

A young woman developed an acute transmural infarction due to an acute thrombosis of the left anterior descending coronary artery, probably induced by a previous abuse of intravenous heroin.

Topics: Adult; Coronary Thrombosis; Female; Heroin; Humans; Myocardial Infarction; Substance Abuse, Intravenous

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

Topics: Blood Pressure; Cyclizine; Heroin; Humans; Hypotension, Orthostatic; Injections, Intravenous; Morphine; Myocardial Infarction; Pain

Topics: Aged; Algorithms; Electrocardiography; Female; Heroin; Humans; Male; Middle Aged; Myocardial Infarction; Pain Measurement; Time Factors

Topics: Aged; Analgesics; Dose-Response Relationship, Drug; Female; Heroin; Humans; Male; Middle Aged; Myocardial Infarction; Time Factors

Topics: Buprenorphine; Cost-Benefit Analysis; Heroin; Humans; Morphinans; Myocardial Infarction

Topics: Buprenorphine; Heroin; Humans; Morphinans; Myocardial Infarction; Respiratory Insufficiency

Three cases of hypoxic-ischemic leukoencephalopathy were studied. In two patients, the neurologic disorder followed drug overdosage; in the third, the apparent precipitating event was a postoperative myocardial infarction complicated by circulatory insufficiency. All patients were deeply unresponsive, with varying reflex patterns. In all three cases, the brain showed extensive symmetrical necrotic lesions of the central white matter, with minimal damage to gray matter structures. The lesions in case 3 showed, in addition, vascular necrosis and ring hemorrhages. Common to all cases was a prolonged period of hypoxemia, hypotension, and elevated venous pressure. Acidosis occurred in two. These observations and analysis of previous reports of similar cases suggest that leukoencephalopathy tends to occur when the hypoxemia is prolonged and is associated with periods of hypotension and metabolic imbalance.

Topics: Adult; Aged; Brain; Brain Damage, Chronic; Female; Glutethimide; Heroin; Humans; Hypotension; Hypoxia, Brain; Ischemia; Male; Myocardial Infarction

Topics: Catecholamines; Cyclizine; Diplopia; Electrocardiography; Fecal Impaction; Headache; Heart Rate; Heroin; Histamine Release; Humans; Hypertension; Lidocaine; Male; Myocardial Infarction; Pentazocine; Pheochromocytoma; Practolol

Topics: Analgesics; Diazepam; Heart; Hemodynamics; Heroin; Humans; Hydromorphone; Meperidine; Methadone; Morphine; Myocardial Infarction; Nitrogen Oxides; Pain; Pentazocine; Respiration

Serum creatine kinase (CK) was measured in blood donors, patients admitted to hospital with suspected myocardial infarction, and healthy hospital personnel to investigate the normal range, the daily variation in healthy people, and the effect of intramuscular injections of pentazocine or diamorphine.There was considerable daily variation in the healthy controls, apparently related to exercise. In defining both the normal range and the significance of day-to-day increases in the serum CK account should be taken of this factor. An upper limit of normal of 210 IU/1. Should apply to previously ambulant patients and of 165 IU/1. to patients previously at rest. An increase greater than 85% in successive daily values is uncommon in health.Intramuscular injections of both pentazocine and diamorphine caused a significant rise in the serum CK in six out of 25 patients. The highest rise observed was from 64 IU/1. to 395 IU/1. Caution is therefore urged in the diagnosis of myocardial infarction from the serum CK values when these intramuscular injections have been given.

Topics: Circadian Rhythm; Creatine Kinase; Diagnosis, Differential; Female; Heroin; Humans; Injections, Intramuscular; Male; Myocardial Infarction; Pentazocine; Physical Exertion

Topics: Alcoholism; Angina Pectoris; Aortic Aneurysm; Arrhythmias, Cardiac; Atrial Fibrillation; Atrial Flutter; Hemodynamics; Heroin; Humans; Hypertension; Hyperthyroidism; Migraine Disorders; Myocardial Infarction; Pacemaker, Artificial; Pheochromocytoma; Propranolol; Substance-Related Disorders; Tachycardia, Paroxysmal; Tetralogy of Fallot; Tremor; Wolff-Parkinson-White Syndrome

Topics: Adult; Brain; Cocaine; Demyelinating Diseases; Electrocardiography; Heroin; Heroin Dependence; Humans; Infarction; Male; Morphine; Myelitis; Myelitis, Transverse; Myocardial Infarction; Paralysis; Substance-Related Disorders

Topics: Analgesics; Heroin; Humans; Morphine; Myocardial Infarction; Pain; Pentazocine

Topics: Analgesics; Heroin; Humans; Meperidine; Morphine; Myocardial Infarction; Pentazocine

Topics: Heroin; Humans; Morphine; Myocardial Infarction

Topics: Adult; Aged; Blood Pressure; Blood Volume; Cardiac Output; Female; Heart Rate; Hemodynamics; Heroin; Humans; Male; Middle Aged; Myocardial Infarction; Vascular Resistance

Topics: Heroin; Humans; Myocardial Infarction