Cardiovascular Complications of Opioid Use JACC State-of-the-Art Review

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY

卷:77

Review

Krantz, Mori J.^1,2  Palmer, Robert B.³  Haigney, Mark Cp⁴ 

[1] Univ Colorado, Sch Med, Aurora, CO USA

[2] Denver Hlth, Div Cardiol, Denver, CO USA

[3] Denver Hlth, Rocky Mt Poison & Drug Safety, Denver, CO USA

[4] Uniformed Serv Univ Hlth Sci, Cardiol Div, Mil Cardiovasc Outcomes Res, Bethesda, MD USA

关键词: arrhythmia;    dextromethorphan;    endocarditis;    hERG channel;    levacetylmethadol;    loperamide;    methadone;    mortality;    opioids;    opioid overdose;    opioid mortality;    opioid withdrawal;    propoxyphene;    QT-prolongation;    torsade de pointes;   

DOI  :  10.1016/j.jacc.2020.11.002

来源: Elsevier

【 摘 要 】

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 p.-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. (C) 2021 The Authors. Published by Elsevier on behalf of the American College of Cardiology Foundation.

【 授权许可】

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