Heroin Addiction and Related
Clinical Problems 2009; 11(4):5-10
Caldarola
P., Cuonzo M.
Correspondence: Pasquale
Caldarola, MD, Cardiologic Unit, "M. Sarcone" Hospital, Via P. Fiore,
153 - 70038 Terlizzi, Bari, Italy E-mail:bari4@cardionet.it
Summary: The electrocardiogram records the electrical activity of the
heart, the depolarization and repolarization of the atria and ventricles.
Deflections are all shown by the single features of the electrocardiogram: the
P wave, the QRS complex, the T wave, the U wave, the PR interval and the QT.
The QT interval represents the entire electrical activity of the left
ventricle: it begins with the onset of ventricular depolarization (start of the
Q wave) and is completed when ventricular repolarization ends (at the end of
the T wave). Measurement of the QT interval is important because of the useful
information it provides on the electrical activity of the heart; the length of
the interval depends on various pathophysiological conditions, changes in
electrolyte concentration, and the pharmacological action of toxic substances.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):11-20
Psychoactive Drugs and
Prolongation of the QT Interval
Deruvo
G., Vendramin A., Di Sciascio G.
Correspondence: Gaetano Deruvo,
MD - SerT AUSL BA/4 - Via Giovanna da Durazzo, 53 - 70032 Bitonto (BA),
Italy E-mail:
<deruvogaetano@libero.it>
Summary: The links between psychiatry and cardiology that are pertinent to
potential cardiovascular risks associated with the use of psychotropic drugs,
especially antipsychotics, cannot be viewed as entirely new. In Italy, however,
an important innovation was made when, on 28 February 2007, the Italian
Medicines Agency (AIFA), issued a directive laying down provisions for the
amendment of the printed papers that accompany various medicines, including
haloperidol; that initiative has revived the relevance of the whole question.
In particular, contraindications to the use of these drugs have been redefined.
The primary ones are now listed as acute myocardial infarction, decompensated
heart failure, arrhythmias treated with antiarrhythmic drugs belonging to
special classes, the prolongation of the QT interval corrected for heart rate
(QTc), the family history for arrhythmia or torsades de pointes, hypokalaemia
and the concomitant use of drugs that prolong the QTc.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):21-28
Opioid Treatment and
“Long-QT Syndrome (LQTS)”: a Critical Review of the Literature
Pacini
M., Maremmani A. G. I., Dell'Osso L., Maremmani I.
Correspondence: Matteo Pacini,
MD, "G, De Lisio" Institute of Behavioural Sciences, Via di Pratale,
3 - 56127 Pisa, Italy E-mail: paciland@virgilio.it
Summary: The present review aims at perusing the available literature
about QT-related cardiac safety during methadone treatment. On the whole, case
reports, either single or multiple, do not seem a reasonable bases to draw
conclusions about the weight of any putative risk factor for QT prolongation.
On the other hand, systematic studies allow making some statements about the extension
and weight of QT prolongation during methadone maintenance treatment for heroin
addiction. No major concern about cardiac safety of methadone itself in the
average addict seems to stand. Conditions at higher risk of multiple and
polydrug treatments deserve some greater surveillance. No rationale for a
dose-ceiling stands in a risk/benefit perspective.
Publication Type: Review
Heroin Addiction and Related
Clinical Problems 2009; 11(4):29-34
Management of Cardiac Risk
during Methadone Treatment: Focus on the QT Interval
Pani P.
P.
Correspondence: Pier Paolo
Pani, MD - Director Social-Health Service, Health District 8 (ASL 8),
Cittadella della Salute, Padiglione C, Via Romagna, 16 - 09100 Cagliari, Italy,
EU. Phone +39 070 47443701; E-mail: pallolo@tin.it
Summary: In recent years, methadone, along with various other drugs, has
been implicated in the lengthening of the QT interval of the electrocardiogram
(ECG) and in the onset of potentially fatal arrhythmias. The risk of prolonged
QT in methadone-maintained subjects is estimated at between 2-4%, while the
risks of torsades de pointes or sudden death are extremely low. Despite the
diversities reported, the guidelines available to date indicate the need to
implement preventive measures based on ECG screening.
The impact of these
recommendations is, however, limited by the lack of a comparative risk/benefit
assessment of specific procedures.
Publication Type: Seminar
Heroin Addiction and Related
Clinical Problems 2009; 11(4):35-40
Cardiovascular
Complications of Cocaine Use
Gambarana
C.
Correspondence: Carla
Gambarana, MD, Dept. Neuroscience, University of Siena, Via Aldo Moro, 4 -
53100 Siena, Italy E-mail: gambarana@unisi.it
Summary: As cocaine use has become prevalent, an increasing number of
reports of cocaine-associated morbidity and mortality, largely because of
central nervous system and cardiovascular toxicity, appeared. Cardiovascular
toxicity is broad, and it may also lead to neurological, psychiatric and other
organ-specific symptoms. Cocaine may induce myocardial ischemia by increasing
myocardial oxygen demand while simultaneously decreasing myocardial oxygen
supply. Most of the cardiovascular toxic effects elicited by cocaine are likely
related to its ability to selectively bind to the L-type calcium channels and
the potassium channels that modulate the Ikr current. In addition, cocaine may
promote intracoronary thrombosis in the absence of coronary atherosclerosis.
This article briefly reviews the current knowledge regarding the cardiovascular
effects of cocaine, providing insight into some of the underpinning mechanisms.
Key Words: adrenergic
receptors, monoamine uptake, L-type calcium channels, acute coronary events
Publication Type: Seminar