Femke Margaretha Johanna Gresnigt

Hyperthermia represents a medical emergency resulting from an imbalance between heat generation and the body’s capacity for heat dissipation, defined as core body temperature elevation beyond 39.0 ...

The World Drug Report 2025 highlights a global increase in recreational drug use, with 6% in individuals aged 15–64 reporting consumption in the past year—an alarming 28% surge over the past decade...

Recreational drugs affect the cardiovascular system through distinct mechanisms; however, data regarding their cardiovascular impact in the emergency department setting is limited. This study aimed to assess the incidence of cardiovascular effects following recreational drug use in presentations to the emergency department, identify the main drug groups involved, and compare cases with and without cardiovascular effects. Data were extracted from the European Drug Emergency Network (Euro-DEN Plus) dataset from October 2013 to December 2021. Recreational drugs were categorised into ten main drug groups: opioids, cocaine, crack cocaine, cannabis, 3,4-methylenedioxymethamfetamine, amfetamine-type stimulants, gamma-hydroxybutyrate and gamma-butyrolactone, hallucinogens, benzodiazepines, and ketamine. Among 59,571 presentations, 13,905 (23.3%) involved cardiovascular effects. Cocaine (OR 3.19, 95% CI 2.99-3.39) and 3,4 methylenedioxymethamphetamine (OR 1.18, 95% CI 1.13-1.23) showed the strongest associations with cardiovascular features, including chest pain, palpitations, hypertension, and arrhythmias. Opioids (OR 0.35, 95% CI 0.31-0.38) and benzodiazepines (OR 0.38, 95% CI 0.32-0.44) were associated with less frequent cardiovascular features. Patients with cardiovascular features exhibited higher median values for temperature, heart rate, blood pressure, and respiratory rate (p <0.001). Cardiovascular features were associated with an increased risk of intubation (OR 1.91, 95% CI 1.70-2.15), critical care admission (OR 2.18, 95% CI 2.00-2.38), and mortality (OR 15.8, 95% CI 7.36-33.9). Cardiovascular effects were common in acute recreational drug toxicity. Cocaine and amfetamine-type stimulants increased the risk of chest pain and arrhythmias, with chest pain being a key indicator of acute coronary syndrome. Cardiovascular effects were more frequently observed with cocaine than with crack cocaine. Cannabis was positively associated with palpitations but not arrhythmias. Gamma-hydroxybutyrate and gamma-butyrolactone, opioids, and benzodiazepines were linked to hypotension. The presence of cardiovascular effects was associated with worse outcomes, underscoring the need for thorough cardiac assessment. Cardiovascular effects were present in almost a quarter of emergency department presentations with acute recreational drug toxicity, particularly involving cocaine and 3,4 methylenedioxymethamphetamine.

Recreational drug use is common, with a prevalence of 4.7% among Dutch outgoing people. Stimulant drugs and cannabis are associated with cardiovascular complications such as, palpitations, chest pain, syncope, hypertension, tachycardia, QRS-widening, QTc-prolongation, arrhythmia, acute coronary syndrome, and even sudden cardiac death. The self-reported drug use reliability is mostly poor, although specific questioning might increase this reliability. For risk stratification in chest pain patients, the HEART-score can be used, without adjustment. A prolonged observation duration, as previously advised, seems unnecessary. Treatment includes sedatives, antihypertensives, coronary angiography, and specific antiarrhythmics followed by the appropriate intervention for acute coronary syndrome. For arrhythmia, labetalol, carvedilol, lidocaine and sodium bicarbonate can be considered. The use of beta-blockers is still under debate but should be considered in patients with heart failure with reduced ejection fraction. Therefore, always question patients with cardiovascular complaints about recreational drug use, know this changes management, and provide drug counselling.

This study primarily aimed to assess the ability to detect major cardiac events using the history, electrocardiogram, age, risk factors and troponin (HEART) pathway, modified cocaine HEART score, and HEART score among patients with cocaine-associated chest pain. This single-centre retrospective study included consecutive patients with cocaine-associated chest pain admitted between January 2016 and December 2022 who were age and sex-matched in a 1:2 ratio to patients with chest pain not associated with cocaine use. The primary outcome was the percentage of major adverse cardiovascular events within 30 days. In total, 1,412 patients were included, with 1,653 presentations, of whom 551 presented with cocaine-associated chest pain and were ≥18 years old. Most presentations involved male patients (84%). Major adverse cardiovascular events occurred in 139 presentations: 50 (9.1%) among patients with cocaine-associated chest pain and 89 (8.1%) among patients with non-cocaine-associated chest pain. The number of low-risk presentations of cocaine-associated chest pain patients was 409 (74.2%), 345 (62.6%) and 394 (71.5%) according to the HEART score, modified cocaine HEART score and HEART pathway, respectively. The HEART pathway had the lowest percentage of observed major adverse cardiac events in low-risk patients (0%; 95% CI: 0-0.9%), followed by the modified cocaine HEART score (0.3%; 95% CI: 0.007-1.6%) and the HEART score (0.7%; 95% CI: 0.2-2.1%). Sensitivity, negative predictive value, and area under the curves were very similar between the three scores. The occurrence of missed major adverse cardiovascular events in low-risk patients was below 0.7% (95% CI: 0.2%-2.1%) in all three risk stratification scores. The HEART pathway was the safest risk stratification tool with a sensitivity and negative predictive value of 100%. Nevertheless the differences with the other risk stratification scores were non-significant. All three risk stratification scores performed well in a low-risk population with cocaine-associated chest pain, with a percentage of 0.7% of patients with a missed major adverse cardiovascular event.

This study hypothesized that 3,4-methylenedioxymetamfetamine intoxication presents with distinct clinical features and outcomes when combined with other substances of misuse, compared to mono-3,4-methylenedioxymetamfetamine intoxication. This study investigated the clinical presentation of acute mono-3,4-methylenedioxymetamfetamine intoxication, 3,4-methylenedioxymetamfetamine intoxication with exclusive co-usage of ethanol, and 3,4-methylenedioxymetamfetamine-co-intoxication with co-usage of other substances with or without ethanol, with a focus on patient sex differences. A retrospective analysis was conducted using the Euro-DEN Plus database (2013-2022), which collects data on emergency department presentations with acute drug intoxication from 28 sentinel centres in 18 European countries. Odds ratios for clinical features were calculated for the three study groups with mono-3,4-methylenedioxymetamfetamine intoxication as the reference group. A sub-analysis explored patient sex differences in clinical features. Among 4,102 presentations, 3,4-methylenedioxymetamfetamine-ethanol intoxication (n = 1,376) was associated with increased odds of agitation (OR: 1.34), drowsiness (OR: 2.30), and vomiting (OR: 1.85) compared to mono-3,4-methylenedioxymetamfetamine intoxication (n = 359). 3,4-Methylenedioxymetamfetamine-co-intoxication (n = 2,367) was associated with higher odds of bradycardia (OR: 3.14), psychosis (OR: 1.91), and coma (OR: 1.72). Mortality rates did not significantly differ across groups. Females reported a lower incidence of chest pain (OR 0.78) while reporting higher rates of vomiting (OR: 1.64), headache (OR: 1.61), and hypotension (OR: 1.89) compared to males. The variation in clinical manifestation of acute 3,4-methylenedioxymetamfetamine intoxication is associated with co-intoxication and patient sex. Co-intoxication with ethanol or other substances was associated with an increased incidence of more severe symptoms, such as agitation and psychosis, necessitating tailored management. These variations suggest the need for physicians to consider the type of co-intoxication and patient sex to optimize treatment strategies. Although co-intoxication affected the clinical trajectory, the mortality risk remains low. Ethanol co-intoxication, co-intoxication with other substances of misuse, and patient sex were associated with varying clinical presentations in the emergency department, necessitating tailored treatment approaches.

Hydroxychloroquine has cardiac and cerebral sodium channel- and human ether-à-go-go-related gene (HERG) potassium channel-blocking effects. This causes depolarization delays, resulting in cardiovascular toxicity with potentially fatal consequences. Despite several supportive care options, hydroxychloroquine poisoning remains difficult to treat. Its high lipid solubility suggests that lipid emulsion therapy might be beneficial; however, no clear evidence regarding its efficacy is available. The aim of this review is to assess the evidence, the outcomes, and adverse events regarding the use of intravascular lipid emulsion therapy as a treatment for hydroxychloroquine poisoning. We conducted a systematic search in PubMed, Embase.com, Cochrane Central Register of Controlled Trials (CENTRAL)/Wiley, Web of Science Core Collection/Clarivate Analytics, and Scopus/Scopus.com from inception until 1 November 2023. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Inclusion criteria encompassed original observational or interventional studies, case series and case reports describing patients receiving lipid emulsion therapy for hydroxychloroquine toxicity. We extracted clinical data and performed a quality assessment of the included cases. We present the results as a narrative synthesis. Of 157 identified articles, 16 case reports met the inclusion criteria, reporting on 18 patients. Lipid emulsion therapy was always associated with additional treatments, and detailed information on the circumstances regarding the administration of intravenous lipid emulsion and its presumed effect was often lacking. Fifteen of 18 patients survived to hospital discharge. Some reports described clear and almost immediate clinical improvement after intravenous lipid emulsion administration. No clear adverse effects were reported. A limitation is the reliance on case reports, which varied in the degree of reported details. The administration of multiple therapeutic drugs in most cases made it difficult to attribute survival primarily to lipid emulsion. Publication bias may favour cases with successful outcomes. Among published case reports, most patients who received lipid emulsion for treatment of hydroxychloroquine poisoning survived. The risk of bias, the small number of reports, and the lack of systematic reporting of both favourable and adverse effects limit any conclusions about the effectiveness of lipid emulsion for hydroxychloroquine poisoning.