Many people are aware of the impact of recreational drugs on the brain and central nervous system. Less well-known, despite causing an important number of deaths, is the impact on the heart and circulatory system. Methamphetamines and cocaine are among the most well-known to cause heart failure but opioids can have negative consequences as well.
In addition to addiction, most illegal drugs can have negative cardiovascular effects, ranging from an abnormal heart rate to a heart attack. Illegal drug injection can also lead to cardiovascular problems, such as collapsed veins and bacterial infections of the blood vessels and heart valves.
Doctors have to manage the life-threatening effects of these drugs. Early diagnosis and intervention and referral for substance abuse treatment are the key. In this article I summarize these effects, symptoms and what can be done to prevent them.
Impact of Drugs and Alcohol on the Heart
The symptoms of heart failure from drugs are similar to those of other types of heart disease. These symptoms can also occur with other illnesses, so it is important that a person consult a doctor if they experience:
- Breathlessness, especially when lying down
- Chronic cough
- Fluid retention that causes swelling of the feet or ankles
- Extreme fatigue
- Unwell feelings when completing daily activities
The side effects and risks for your heart associated with the use of these drugs include:
- Changes in body temperature, heart rate and blood pressure
- The possibility of added substances, such as talc, poisons, herbicides or other particles, which may cause a toxic reaction
- High blood pressure, arrhythmias, cardiomyopathy (effects on heart muscle), peripheral artery disease, increased blood clotting and plaque formation in the arteries
- Restricted blood flow, heart attacks, other acute coronary events and stroke
- Increased mortality in those with preexisting cardiovascular disease
Amphetamines
- Stimulate the central nervous system (nerves and brain), which increases heart rate and blood pressure, among other effects
Cocaine (the “perfect heart attack” drug)
In addition to its impact on the cardiovascular system, cocaine also has an important negative impact on the heart, leading to:
- Arrhythmias (irregular heartbeat)
- Cardiomyopathy (effects on the heart muscle)
- Higher blood pressure, stiffer arteries and thicker heart muscle walls.
- Sharp rise in heart rate and an increased need for oxygen in heart muscle.
- Angina and reduced blood flow to the heart.
- Damage to cardiac tissue.
- Heart infections
- All of the above issues can lead to a heart attack, heart failure, stroke or aneurysm.
- Drug-induced heart failure
- Acute myocardial infarction: heart attack due to formation of plaques in the interior walls of the arteries resulting in reduced blood flow to the heart and injuring heart muscles because of lack of oxygen supply.
Ecstasy
- Affects blood pressure and heart rate
Opioids
- Injecting opioids can lead to infective endocarditis, a serious infection of the heart lining from using dirty needles
- Cardiac arrest
- May interfere with medications used to manage and treat cardiovascular disease and stroke
Effect of Drugs on the Cardiovascular System
Cocaine
One of the illegal drugs which impacts the cardiovascular system the most is cocaine.
It inhibits the reuptake of several neurotransmitters involved with pleasure in the brain: norepinephrine, dopamine and serotonin.
Cocaine has a variety of important effects on the cardiovascular (heart and blood vessels) system by causing abnormal, depressed cardiovascular activity. As well, it increases cardiovascular complications such as:
- Hypertension (high blood pressure)
- Coronary spasm (tightening of the walls of the arteries that send blood to the heart)
- Hardening of the arteries
- Coronary artery disease
And when taken with alcohol, cocaine levels in the blood are significantly increased, leading to increased, prolonged cardiovascular risks
Ecstasy
- Affects blood pressure and heart rate
Marijuana
- Smoking marijuana can make the heart beat faster and can make blood pressure higher immediately after use
- Can also lead to increased risk of stroke, heart disease and other vascular diseases
Opioids
Increases risk of:
- Arrhythmia: Changes in heartbeat rhythm leading to heart attack or stroke
- Low blood pressure
- Heart failure
- Cardiac arrest
- Inflammation of heart’s inner lining
Can Your Heart Heal From Drug Abuse?
Cocaine
Recent research at Johns Hopkins University showed that stopping or reducing cocaine use can potentially reverse the process of coronary atherosclerosis. In particular, reducing cocaine use leads to regression of unstable, noncalcified coronary plaques — the type most likely to cause a heart attack or stroke. This is promising research.
Methamphetamines
Treatment for drug-induced heart failure from meth use begins with removing the drug, if at all possible. In some cases, stopping drug use may even reverse symptoms. For example, a 2017 study, published in the Journal of the American College of Cardiology, found that meth users with meth-induced heart failure could reduce or reverse heart damage and lower the risk of heart failure or even reverse its symptoms by stopping their drug use.
“The work … emphasizes the fact that the growing drug epidemic will have long-term cardiovascular consequences in addition to the known short-term tragic events,” said Editor-in-Chief of JACC: Heart Failure Christopher O’Connor, MD, FACC.
In addition, James L. Januzzi, MD, Hutter Family Professor of Medicine at Harvard Medical School in Boston, said the study provides objective data showing that in methamphetamine abusers, cardiac function will only improve after they quit using the drugs, and these findings should impact the treatment plan.
He said, “Rather than simply placing patients with suspected methamphetamine-associated cardiomyopathy on a cocktail of neurohormonal blockade, the majority of focus should be on helping such patients quit.”
Heart Damage Prevention
Simply put, the best prevention from drug-induced heart failure is to stop using illegal drugs, especially stimulants. If you don’t stop, then using harm reduction strategies such as lower doses or reducing the frequency of use may be of help. Those who have heart-related issues should consult a doctor. It’s important to look at risks and benefits as many drugs affect the heart.
A heart-healthy lifestyle may include:
- maintaining a moderate weight
- avoiding smoking
- reducing consumption of trans fats
- eating a balanced diet
- becoming more physically active
Sources
Ghuran A, Nolan J. The cardiac complications of recreational drug use. West J Med. 2000 Dec;173(6):412-5. doi: 10.1136/ewjm.173.6.412. PMID: 11112762; PMCID: PMC1071198.
Illegal Drugs and Heart Disease. 2024. American Heart Association.
Kim ST, Park T. Acute and Chronic Effects of Cocaine on Cardiovascular Health. Int J Mol Sci. 2019 Jan 29;20(3):584. doi: 10.3390/ijms20030584. PMID: 30700023; PMCID: PMC6387265.
Stopping Drug Abuse Can Reverse Related Heart Damage. American College of Cardiology.
Villenes Z. 2023. Drug-induced heart failure: Risks and more. MedicalNewsToday.
