Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2020 Jun 2;9(11):e016704.
doi: 10.1161/JAHA.120.016704. Epub 2020 May 29.

Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review

Pavan K V Reddy  1 , Tien M H Ng  2 , Esther E Oh  2 , Gassan Moady  1 , Uri Elkayam  1
Affiliations
Review

Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review

Pavan K V Reddy et al. J Am Heart Assoc. .

Abstract

Methamphetamine-associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short- and long-term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.

Keywords: cardiomyopathy; diagnosis; heart failure; management; methamphetamine.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Proposed pathophysiologic mechanisms for the development of methamphetamine‐associated cardiomyopathy.
Dysfx indicates dysfunction.
Figure 2
Figure 2. Histological examples of patients with discontinued and continued methamphetamine (MA) abuse over different time periods.
Longer and continued MA abuse (>5 years) is associated with a high degree of fibrosis and myocyte damage (magnification >200). Reprinted from Schürer et al29 with permission. Copyright ©2017, Elsevier. LV‐EF indicates left ventricular ejection fraction.
Figure 3
Figure 3. Management of acute and chronic methamphetamine (MA)–associated cardiomyopathy presentations.
*Caution is advised if patient is actively using MAs. BDZ indicates benzodiazepines; GDMT, guideline‐directed medical therapy; HF, heart failure; IVF, intravenous fluid; MCS, mechanical circulatory support; NPPV, noninvasive positive pressure ventilation; RHC, right heart catheterization; and VAD, ventricular assist device.
See this image and copyright information in PMC

References

    1. Rasmussen N. Making the first anti‐depressant: amphetamine in American medicine, 1929–1950. J Hist Med Allied Sci. 2006;61:288–323. - PubMed
    1. Vearrier D, Greenberg MI, Miller SN, Okaneku JT, Haggerty DA. Methamphetamine: history, pathophysiology, adverse health effects, current trends, and hazards associated with the clandestine manufacture of methamphetamine. Dis Mon. 2012;58:38–89. - PubMed
    1. Rasmussen N. Amphetamine‐type stimulants: the early history of their medical and non‐medical uses. Int Rev Neurobiol. 2015;120:9–25. - PubMed
    1. Romanelli F, Smith KM. Clinical effects and management of methamphetamine abuse. Pharmacotherapy. 2006;26:1148–1156. - PubMed
    1. National Institute on Drug Abuse (NIDA) Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group, Highlights and Executive Summary. Bethesda, MD: U.S. Department of Health and Human Services, National Institutes of Health, 2012.

MeSH terms

Substances