Title:The Cardiac Conduction and Contractility Complications of Methamphetamine Use and the Relationship to Psychiatric Comorbidity: A Systematic Review
VOLUME: 16 ISSUE: 1
Author(s):Sarah Baker* and David Castle *
Affiliation:Psychiatry Registrar, St. Vincent’s Health, 46 Nicholson Street, Fitzroy, 3065, Chair of Psychiatry, St. Vincent’s Health, 46 Nicholson Street, Fitzroy, 3065
Keywords:Cardiomyopathy, arrhythmia, methamphetamine, psychiatry, electrocardiograph, echocardiograph.
Abstract:
Background: Methamphetamine has the potential to produce more severe short and long
term effects than typical amphetamines due to the drug’s increased purity. The cardiovascular consequences
compromise a large proportion of the drug’s mortality. Previous reviews have not examined
these complications in relation to psychiatric patients who have high rates of substance use and
physical comorbidity.
Methods: Ovid Medline, Embase, Emcare, PsycINFO, CINAHL, and Cochrane were systematically
searched in English until November 2017. Data were coded according to study design, sample size,
demographics, medical and psychiatric comorbidity, electrocardiograph abnormalities, echocardiograph
parameters, illness severity, treatment, and outcome on follow up.
Results: The 11 included studies were predominantly case series conducted in the USA. Males were
more likely to use methamphetamine and be associated with global systolic dysfunction. The mean
age was lower for those with methamphetamine-related cardiovascular complications. QTc interval
prolongation was the most frequent electrocardiograph abnormality. Continued methamphetamine
use was associated with persistently impaired ventricular function, whilst discontinuation led to
remodeling and improved ejection fraction. Only one study referenced psychiatric comorbidity or
dual diagnosis.
Conclusion: This review describes the range of variables related to methamphetamine associated
arrhythmias and cardiomyopathies. Early detection of methamphetamine use and the subsequent
cardiac complications is important, especially in a psychiatric cohort where physical illness is more
commonly neglected. The monitoring of electrocardiographs in methamphetamine users is also
crucial. Future research is needed to allow for appropriate recommendations in managing the harmful
impacts of methamphetamine use in this population.
