From the Guidelines
Cocaine is the most common street drug that can cause elevated troponin levels, followed by methamphetamine, MDMA (ecstasy), synthetic cannabinoids (K2, Spice), and heroin or other opioids. These drugs can cause troponin elevation through various mechanisms, including coronary vasospasm, increased oxygen demand, accelerated atherosclerosis, direct cardiotoxicity, and hypoxia. The most recent and highest quality study, 1, highlights the importance of considering substance use history in patients with unexplained troponin elevation, especially with chest pain or other cardiac symptoms. Key points to consider include:
- Cocaine can cause troponin elevation through coronary vasospasm, increased oxygen demand, and direct cardiotoxicity
- Methamphetamine can lead to cardiomyopathy with chronic use and cause troponin elevation through similar mechanisms as cocaine
- MDMA (ecstasy) can raise troponin levels through increased heart rate, blood pressure, and direct cardiac toxicity
- Synthetic cannabinoids (K2, Spice) have been associated with myocardial injury and troponin elevation
- Heroin and other opioids can cause troponin elevation indirectly through hypoxia from respiratory depression or when cut with cardiotoxic adulterants. It is essential to consider drug screening and a thorough substance use history as part of the evaluation for patients with unexplained troponin elevation, especially with chest pain or other cardiac symptoms.
From the FDA Drug Label
Literature reports suggest that amphetamines may be associated with significant elevation of plasma corticosteroids. The FDA drug label does not answer the question about street drugs that can cause an elevation in troponin, but it does mention that amphetamines, such as methamphetamine, may be associated with significant elevation of plasma corticosteroids, which can be related to cardiac issues. Key points:
- Methamphetamine is an amphetamine
- Amphetamines may be associated with elevation of plasma corticosteroids
- Elevated plasma corticosteroids can be related to cardiac issues, such as elevation of troponin However, the label does not directly address the question of street drugs that can cause an elevation in troponin. 2
From the Research
Street Drugs and Troponin Elevation
The following street drugs have been studied in relation to troponin elevation:
- Cocaine: Studies have shown that cocaine use can lead to elevated troponin levels, indicating cardiac injury 3, 4, 5, 6.
- Fentanyl: One study found that fentanyl use was significantly associated with higher high-sensitivity troponin I levels, suggesting myocardial injury 4.
- Cocaethylene: Cocaethylene, a metabolite of cocaine, has also been associated with higher high-sensitivity troponin I levels 4.
- Methamphetamine: While not directly linked to troponin elevation, methamphetamine use has been identified as a potential risk factor for cardiovascular disease 4.
- Heroin and other opioids: Opioid use has been linked to cardiovascular disease, but its direct relationship to troponin elevation is not well established 4.
Mechanisms of Troponin Elevation
The mechanisms by which these street drugs lead to troponin elevation are not fully understood, but may include:
- Coronary vasospasm: Cocaine use can cause coronary vasospasm, leading to cardiac ischemia and troponin elevation 3, 6.
- Myocardial infarction: Cocaine and other street drugs can increase the risk of myocardial infarction, which can lead to troponin elevation 4, 5, 6.
- Cardiomyopathy: Chronic use of certain street drugs, such as cocaine, can lead to cardiomyopathy and troponin elevation 6.