Cardiovascular Complications of Opioid Use: JACC State-of-the-Art Review |
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Authors: | Mori J. Krantz Robert B. Palmer Mark C.P. Haigney |
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Affiliation: | 1. University of Colorado, School of Medicine, Aurora, Colorado, USA;2. Denver Health, Division of Cardiology, Denver, Colorado, USA;3. Rocky Mountain Poison and Drug Safety, Denver Health, Denver, Colorado, USA;4. Military Cardiovascular Outcomes Research, Cardiology Division, Uniformed Services University, Bethesda Maryland, USA |
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Abstract: | Opioids are the most potent of all analgesics. Although traditionally used solely for acute self-limited conditions and palliation of severe cancer-associated pain, a movement to promote subjective pain (scale, 0 to 10) to the status of a “fifth vital sign” bolstered widespread prescribing for chronic, noncancer pain. This, coupled with rising misuse, initiated a surge in unintentional deaths, increased drug-associated acute coronary syndrome, and endocarditis. In response, the American College of Cardiology issued a call to action for cardiovascular care teams. Opioid toxicity is primarily mediated via potent μ-receptor agonism resulting in ventilatory depression. However, both overdose and opioid withdrawal can trigger major adverse cardiovascular events resulting from hemodynamic, vascular, and proarrhythmic/electrophysiological consequences. Although natural opioid analogues are devoid of repolarization effects, synthetic agents may be proarrhythmic. This perspective explores cardiovascular consequences of opioids, the contributions of off-target electrophysiologic properties to mortality, and provides practical safety recommendations. |
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Keywords: | arrhythmia dextromethorphan endocarditis hERG channel levacetylmethadol loperamide methadone mortality opioids opioid overdose opioid mortality opioid withdrawal propoxyphene QT-prolongation torsade de pointes ACS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" acute coronary syndrome AP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" ventricular action potential CAD" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" coronary artery disease CI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" confidence interval maximum serum concentration CNS" },{" #name" :" keyword" ," $" :{" id" :" kwrd0140" }," $$" :[{" #name" :" text" ," _" :" central nervous system ECG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0150" }," $$" :[{" #name" :" text" ," _" :" electrocardiographic FDA" },{" #name" :" keyword" ," $" :{" id" :" kwrd0160" }," $$" :[{" #name" :" text" ," _" :" U.S. Food and Drug Administration hERG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0170" }," $$" :[{" #name" :" text" ," _" :" human cardiac Ether-à-go-go–related gene 50% in vitro inhibitory concentration IDU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0190" }," $$" :[{" #name" :" text" ," _" :" injection drug user the inwardly rectifying potassium current the delayed-rectifier potassium ion current LAAM" },{" #name" :" keyword" ," $" :{" id" :" kwrd0220" }," $$" :[{" #name" :" text" ," _" :" levacetalymethadol MI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0230" }," $$" :[{" #name" :" text" ," _" :" myocardial infarction OR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0240" }," $$" :[{" #name" :" text" ," _" :" odds ratio NOP" },{" #name" :" keyword" ," $" :{" id" :" kwrd0250" }," $$" :[{" #name" :" text" ," _" :" nociceptin/orphanin FQ peptide PRR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0260" }," $$" :[{" #name" :" text" ," _" :" promotional reporting ratio QTVI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0270" }," $$" :[{" #name" :" text" ," _" :" QT Variability Index |
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