The Drug-Induced Cardiotoxicity Website and App

Abused drugs/substances (illicit-, street drugs - IV/inhaled)

Specialities: Addiction medicine · Emergency medicine · Forensic medicine/pathology · Law enforcement · Ophtalmology · Pulmonary medicine

Illicit or 'street' drugs, substances, chemicals and synthetic compounds whether inhaled or i.v. (IVDU) can produce a vast array of respiratory manifestations and complications, that can be life-threatening or fatal (PMID 24144776). These encompass bacterial infections which can involve the lung, pleura, chest wall and heart (PMID 16267325). Links to street names, nicknames of drugs and slang to facilitate history taking are included in a 'News' on right called 'Glossary of drug-related slang/street language'. See also under cocaine, heroin, methamphetamine, opiates, narcotics, vehicle, solvents, talc, starch, cellulose and mercury, alc and/or silica may also be an issue. For imaging, see PMID 8416551, 12376606, 17527131, 23168064, 24144776. The homeless is particularly at risk (PMID 30324539). The 'World Drug Report' provides updated data on the prevalent use and consumption of §abused drugs. See also under body-packing/packers. See also under 'talc retinopathy'.

Frequency - Incidence

Incidence of cardiac adverse event(s) due to the specific drug as assessed by number of reported/published cases in the literature. Red digits in stars indicate: 0 = Very rare, questionable signal · 1 = < 10 cases · 2 = 10-50 cases · 3 = 50–100 cases · 4 = 100-200 cases · 5 = >200 cases

Evidence level/grade

Evidence level for cardiac adverse event(s) due to the specific drug as estimated using Hill’s (1965), Naranjo’s (1981), and Bégaud’s (1985) criteria applied to published cases. Blue digits in stars indicate: 0 = Questionable · 1 = Low · 2 = Moderate · 3 = Robust · 4 = Definite · 5 = Unquestionable, pathognomonic

III - Myocardial ischemia - Coronary artery disease

III.a

Coronary artery disease (acute) - Myocardial ischemia/infarction

VI - Cardiomyopathy

VI.b

Hypertrophic cardiomyopathy

IX - Endocardial involvement

IX.a

Endocarditis (infective)

X - Pulmonary edema - ALI/ARDS

X.b

Pulmonary edema, noncardiogenic (NCPE)

XI - Pulmonary vasculopathies

XI.a

Pulmonary arterial hypertension

XI.b

Acute pulmonary hypertension

XI.e

Pulmonary artery aneurysm(s)

XI.i

Pulmonary veno-occlusive disease

XIII - Thrombosis - Embolism

XIII.h

Mercury pulmonary embolism

XIII.k

Foreign body pulmonary vasculopathy (Excipient lung disease)

XIV - Pleural involvement

XIV.f

Pneumothorax

XIV.g

Empyema

XIV.l

Pneumothorax, bilateral

XV - Chest pain

XV.a

Chest pain (acute or subacute), lone or prominent

XVI - Hemorrhage - Bleeding - Hematoma

XVI.e

Alveolar hemorrhage (AH), diffuse AH (DAH)

XX - Vasculitis

XX.c

Vascultis (pulmonary, extrathoracic or systemic)-ANCA status unknown or negative)

XXI - Mediastinal involvement/injury

XXI.c

Pneumomediastinum

XXI.d

Mediastinitis

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

ARDS - Acute lung injury

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

XXIV.d

Acute eosinophilic pneumonia (AEP)

XXIV.o

A mass or masses

XXIV.t

ILD with a granulomatous component

XXIV.x

Aspiration, aspiration pneumonia (w/wo demonstrable pharyngeal dysmotility)

XXIV.z

Exogenous lipoid pneumonia (subacute, acute)

XXIV.af

Pneumoconiosis (silicosis, talcosis...)

XXVI - Neuromuscular dysfunction

XXVI.b

Diaphragm/inspiratory muscle weakness/paralysis (w/wo ARF)

XXVI.c

Acute myelopathy (can cause ARF)

XXVIII - Large airway involvement including UAO

XXVIII.g

Thermal (burns, frostbite), chemical or caustic injury on the face, mouth, tongue, pharynx or upper airway

XXVIII.p

Nasal, palatal and/or pharyngeal pathology

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma

XXIX.c

Severe or catastrophic bronchospasm or asthma attack (can be fatal)

XXX - Imaging features

XXX.b

Imaging: A miliary pattern (diffuse random micronodules)

XXX.f

Imaging: Alveolar opacities or haze with a batwing or butterfly distribution

XXX.i

Imaging: Cavitating/cavitary lung nodule, mass or nodules (see also Iq, XIs, XIIi, XVIaa and XVIIp)

XXX.k

Imaging: Centrilobular micronodules (can be diffuse)

XXX.n

Imaging: A 'tree-in-bud' pattern

XXXI - Eye catchers

XXXI.e

Eye catcher: A batwing pattern on imaging

XXXIII - Histopathology (for pulmonary pathology see in ‘Pneumotox’ (a free companion App)

XXXIII.l

Path: Pulmonary hypertension incl. angiomatoid vasculopathy

XXXIII.n

Path: Foreign body embolism, microangiopathy, vasculopathy

XXXIV - Infections

XXXIV.a

Septic pulmonary embolism

XXXIV.b

Respiratory tract infection incl. pneumonia

XXXIV.d

Lung abscess/abscesses (see also VIr)

XXXIV.e

Tuberculosis (pulmonary, pulmonary, extrapulmonary or disseminated). Reactivation or de novo

XXXIV.f

Opportunistic pulmonary/systemic infections

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.k

Multiple organ dysfunction/failure (MODS/MOF)

XXXVI.w

Anti-GBM antibody disease (Goodpasture-like or flare of preexisting GS)

XXXVIII - Miscellaneous - Varia

XXXVIII.a

Upper airway obstruction other than angioedema or hematoma

XXXVIII.d

Death following exposure or poisoning

XXXVIII.i

Cough syncope

XXXVIII.w

Foreign body (talc, cornstarch) retinopathy