The Drug-Induced Cardiotoxicity Website and App

E-cigarette - E-vaporizers - ENDS - Vaping - Dabbing

Specialities: Addiction medicine · ICU - I.C.U. · Intensive care medicine · Pulmonary medicine

PMID 31990264, 32758560. Reached epidemic proportions mid-2019, then declining durably. THC, and vitamin-E acetate at the forefront of possible culprit agents. Substances of toxicological interest include ethylene glycol, glycerine, flavoring agents including diacetyl, cannabis (PMID 26347431), tetrahydrocannabinol THC (PMID 25383564, 31491070), vitamin E acetate, such sexual enhancers as tadalafil, poppers (NO vapor), and/or other drugs of abuse (PMID 30245461, 30835796). There is also the risk of nicotine poisoning if the contents of a cartridge is taken orally by children. Careful differential diagnosis and history taking of exposure to tobacco smoke, inhalants, inhaled stimulants, inhaled drugs and/or substances of abuse is indicated in every patient. E-cigarettes in patients on oxygen therapy may produce severe facial burns. Battery explosion and fire can injure the mouth, teeth, face, eye, skin and/or thigh or cause ILD.

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

I - Myocardial dysfunction - Heart failure

I.a

Left or biventricular dysfunction/failure

II - Cardiac arrhythmia(s)/dysrhythmia(s) (AF, VT, VF, TdP) - QTc prolongation)

II.a

Cardiac arrhythmias or dysrhythmias (AF, VT, VF, TdP)

II.e

Bradycardia

XIV - Pleural involvement

XIV.a

Pleural effusion (uni- or bilateral) (can accompany DI-LDs)

XIV.f

Pneumothorax

XV - Chest pain

XV.a

Chest pain (acute or subacute), lone or prominent

XV.d

Chest tightness

XVI - Hemorrhage - Bleeding - Hematoma

XVI.e

Alveolar hemorrhage (AH), diffuse AH (DAH)

XVI.h

Coagulopathy

XVI.i

Hemoptysis

XVI.m

Gross or microscopic bleeding/hemorrhage in lung tissue

XVII - Heart injury/trauma/perforation

XVII.b

Facial/labial/buccal/oral/dental trauma

XXI - Mediastinal involvement/injury

XXI.a

Lymphadenopathy (intrathoracic)

XXI.c

Pneumomediastinum

XXII - Acute respiratory/cardiorespiratory failure

XXII.b

ARDS - Acute lung injury

XXII.c

Acute respiratory failure (e.g. from ARDS, ILD, PIE, OP, pulmonary edema or bronchospasm) requiring ECMO

XXIII - Hemoglobinopathies (acquired, reversible)

XXIII.a

Methemoglobinemia

XXIV - Interstitial lung disease - Pulmonary infiltrates - Pulmonary fibrosis

XXIV.a

Pneumonitis (interstitial lung disease/ILD)

XXIV.b

Pneumonitis (ILD), acute and/or severe (may produce the ARDS pattern)

XXIV.c

Eosinophilic pneumonia (pulmonary infiltrates and eosinophilia)

XXIV.d

Acute eosinophilic pneumonia (AEP)

XXIV.e

Relapsing or migrating pneumonitis/pneumonia (see also Id)

XXIV.k

Organizing pneumonia pattern (an area or areas of consolidation on imaging)

XXIV.m

Acute fibrinous organizing pneumonia (AFOP)

XXIV.t

ILD with a granulomatous component

XXIV.z

Exogenous lipoid pneumonia (subacute, acute)

XXIV.ac

Chronic pneumonitis

XXIV.ad

Pulmonary alveolar proteinosis (PAP) (secondary)

XXVII - Dyspnea, lone

XXVII.a

Dyspnea, unexplained otherwise

XXVIII - Large airway involvement including UAO

XXVIII.b

Epiglottitis

XXVIII.g

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

XXVIII.l

Sputum production - Bonchorrhea - ‘Bronchitis’

XXVIII.m

Bronchiectasis

XXIX - Small airway involvement

XXIX.a

Bronchospasm - Wheezing - Asthma

XXIX.c

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

XXIX.d

Cough (lone)

XXIX.f

Deterioration/exacerbation of preexisting asthma or COPD

XXIX.m

Obstructive airway dysfunction (see also IVc, XVx)

XXIX.n

Reactive airway dysfunction syndrome (RADS)

XXX - Imaging features

XXX.e

Imaging: An area or areas of consolidation

XXX.f

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

XXX.k

Imaging: Centrilobular micronodules (can be diffuse)

XXX.l

Imaging: Ground-glass opacities (GGO) / shadowing

XXX.n

Imaging: A 'tree-in-bud' pattern

XXX.ab

Imaging: Diffuse haze

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.k

Path: Alveolar hemorrhage (see also IIIa)

XXXIII.x

Granulomatous mediastinal lymphadenopathy

XXXIII.y

Path: Acute fibrinous organizing pneumonia (AFOP-pattern)

XXXIV - Infections

XXXIV.b

Respiratory tract infection incl. pneumonia

XXXIV.h

Nontuberculous pulmonary mycobacterial infection/superinfection

XXXVI - Autoimmune syndromes - Systemic reactions or conditions

XXXVI.c

Sarcoid-like granulomatosis (endo-/extrathoracic)

XXXVI.p

Systemic inflammatory response

XXXVIII - Miscellaneous - Varia

XXXVIII.c

Antiphospholipid antibodies w/wo the APL syndrome

XXXVIII.d

Death following exposure or poisoning