From the Guidelines
Yes, methamphetamine use can cause coronary vasospasm.
Mechanism of Action
Methamphetamine affects the central nervous system by stimulating the release and blocking the reuptake of dopamine and norepinephrine, leading to a hyperadrenergic state, which can cause coronary vasoconstriction and increased myocardial oxygen demand, resulting in myocardial ischemia and potentially infarction [ 1, 1 ].
Clinical Presentation
The acute effects of methamphetamine include euphoria, tachycardia, hypertension, and arrhythmias, which can precipitate acute coronary syndromes (ACS) [ 1, 1 ].
Key Considerations
- Methamphetamine use has been associated with myocarditis, necrotizing vasculitis, pulmonary hypertension, and cardiomyopathy [ 1, 1 ].
- Treatment of patients with ACS associated with methamphetamine use should be similar to those with cocaine use, with consideration of the potential for coronary spasm and the need for caution with beta-blocker administration [ 1, 1 ].
- It is essential to inquire about methamphetamine use in patients with suspected ACS, especially in younger patients or those with few risk factors for coronary artery disease [ 1 ].
From the Research
Methamphetamine and Coronary Vasospasm
- Methamphetamine use has been associated with coronary vasospasm, which can lead to acute myocardial infarction and cardiogenic shock, even in individuals with normal coronary arteries 2.
- Studies have reported cases of coronary vasospasm and myocardial injury in patients with a history of methamphetamine use, suggesting a possible link between the two 3, 4.
- The mechanism of methamphetamine-induced coronary vasospasm is not fully understood, but it is thought to involve endothelial dysfunction and alterations in vascular tone 5.
- Methamphetamine use has also been linked to other cardiovascular complications, including hypertension, left ventricular hypertrophy, and coronary artery disease 5, 6.
Clinical Evidence
- A case study published in 2007 reported a young patient who experienced severe global microvascular coronary spasm after methamphetamine use, resulting in acute myocardial infarction 2.
- Another study published in 2021 reported a case of a 39-year-old male who presented with severe chest pain and ST-segment elevation after amphetamine and cannabis use, with coronary angiography showing normal coronary arteries 3.
- A study published in 2003 reported a case of amphetamine-related acute myocardial infarction due to coronary artery spasm, with coronary angiogram showing plaques in the left anterior descending artery 4.
Pathophysiology
- Methamphetamine use has been shown to decrease cardiovascular function via the cystathionine gamma lyase and hydrogen sulfide depletion pathway, leading to endothelial dysfunction and decreased nitric oxide bioavailability 5.
- The reduction in hydrogen sulfide and nitric oxide bioavailability can lead to decreased flow-mediated vasodilation and increased vascular tone, contributing to coronary vasospasm 5.