Prospectively, a convenience sample of patients older than 50 years receiving ketamine for procedural sedation in the ED was used. Recruitment occurred during hours when the three-person research team members were working clinically in the ED. Patients were offered enrollment after sedation choice was made by the treating provider, and informed consent was obtained if patients agreed to enrollment. Ketamine was not required to be the sole agent used and could be administered with other sedating and analgesic agents. Patients were excluded if they were pregnant, incarcerated, or unable to provide informed consent due to a language barrier or mental status. An initial goal of 50 patients was set, but following two years of recruitment, the study was closed to new subjects.
Electrophysiologic and Antiarrhythmic or Arrhythmogenic Effects of Ketamine in Frozen Hearts
[19,20] Thus drug-induced changes in atrial lambda are used to determine the arrhythmogenic or antiarrhythmic properties of drugs on atrial tissue. [21,22] Drugs that increase lambda tend to be antiarrhythmic, whereas agents that decrease lambda tend to be arrhythmogenic on atria. [21] Wavelength has been used to study ventricular reentrant tachycardia, [23] but no data exist concerning its use as an index of the arrhythmogenecity of drugs on ventricles.
For Healthcare Professionals
- Ketamine exhibits antidepressant properties in treatment-resistant depression (TRD) with some concern over its cardiovascular safety and tolerability issues.
- Asthma is a chronic respiratory condition that causes your airways to become narrow and inflamed, leading to difficulty breathing and chest tightness.
- Patient demographics, blood pressure, heart rate, and comorbidity data were retrospectively collected from the electronic medical record.
- The pain feels sharp and usually worsens when you breathe deeply, cough, or do physical activities.
- The clinical and demographic characteristics of the study group are presented in Table 1.
Applying heat or cold packs or gently stretching your torso can help keep your chest flexible and prevent stiffness. Costochondritis occurs when the cartilage that connects your ribs to your breastbone gets inflamed. It can happen after a respiratory infection (e.g., the common cold or flu) or from repetitive chest movements.
Electrophysiological measurements
Follow-up transthoracic echocardiogram showing left ventricular ejection fraction of 54% using the biplane Simpson method with normal left ventricular size. Where possible, the support of friends and family is also fundamental when recovering from ketamine addiction. This leaves plenty of room for excessive amounts of ketamine to be taken, amounts which can lead to an overdose. Likewise, snorting and injecting ketamine are common ways to consume ketamine, so this permits quick entry into the bloodstream. Ketamine has a relatively short half-life (the time required for active substances in the body to reduce by half).
Ketamine Side Effects
INDUCTION of anesthesia with ketamine has been reported to maintain good cardiovascular performance in high-risk patients. [1]This effect of ketamine in vivo is presumably produced through its sympathomimetic activity, exerted via an intact autonomic nervous system. [2]Increases in concentrations of epinephrine and norepinephrine in plasma occur as early as 2 min after intravenous administration of ketamine and return to control levels 15 min later. [3]In the absence of autonomic stimulation, such as in dogs with a pharmacologically blocked autonomic nervous system, infusion of ketamine can decrease cardiac output by 40%.
To our knowledge, this is the first case describing an association of ketamine with acute systolic heart failure. While ketamine overdoses are not strongly linked to death, consuming large amounts of this drug can be fatal. That’s not to say there aren’t any side effects with the drug — and these effects are one reason health experts say people should be under the care of a health care provider during treatment. Some people can experience nausea, vomiting, agitation, hallucinations and a disassociation from reality. “The experience can be a little unusual,” Tankha says — some have even described it as “unnerving” or anxiety-producing.
If you’re interested in learning more about ketamine therapy, skip the mail-order marketers and start by talking to your primary care physician, Tankha says. If they’re not familiar with ketamine, ask to be referred to a provider who is — and then, consider getting a second opinion. “When we’re talking about off-label uses, you want to be an informed consumer and get as much information as possible,” he says. Although not all of these side effects may occur, if they do occur they may need medical attention. Some studies suggest the drug may have other medical uses, but more research is necessary to prove its safety and effectiveness in these areas. People who use it claim that a ketamine trip is superior to a PCP or LSD trip because it produces shorter-term hallucinations that last 30 minutes to an hour instead of several hours.
Metoprolol prevented the cardiotoxicity of ketamine, indicating a promising new therapeutic strategy. Ketamine is a useful medication in procedural sedation; however, careful attention should be made in patient selection when ketamine is the desired agent. Consideration might be made in using the lowest possible 8 best opioid detox and rehab centers dose of ketamine to obtain adequate sedation in order to hopefully lessen the occurrence of ECG changes suggestive of myocardial ischemia. Based on this small sample, single-site study, no evidence of statistically or clinically significant ischemia was seen with the use of ketamine for procedural sedation.
Large-scale studies are required to establish this association and formulate management strategies. Trabecular muscles were obtained from the left ventricles and right atria of 10 patients with heart failure undergoing transplantation and from the right atria of 14 patients undergoing coronary artery bypass surgery. Muscles were dissected and mounted in a 37 degrees C bath and stimulated at 1 Hz.
Ventricular longitudinal and transverse wavelengths tend to increase, but this was not statistically significant. Finally, no arrhythmia could be induced regardless of the ketamine concentration. A 28-year-old female with a history of ketamine use disorder with multiple genitourinary complications presented with progressive bilateral lower extremity oedema that started 3 months prior. She also reported shortness of breath, orthopnoea, chronic cough, and decreased exercise tolerance. She reported using ketamine twice weekly along with smoking half a pack of cigarettes daily. She denied any family history of cardiac diseases and never experienced similar symptoms previously.
Primary outcome was the incidence of new changes suggestive of myocardial ischemia apparent on ECG. Ischemia was defined using the third universal criteria from the Task Force for the Universal Definition of Myocardial Infarction (Table 1) [7]. Secondary outcomes included changes in vital signs after ketamine administration and a case-control analysis comparison of patients with changes suggestive of ischemia to those without. Clinically significant vital sign change was defined as an increase or decrease of greater than or equal to 20% from baseline. Ketamine use disorder is becoming a major concern in the United States and very little long-term data on its cardiovascular side effects is available. Individuals should be counselled on these potential side effects and screening should be considered in patients with a history of ketamine use presenting with acute systolic heart failure.
Official websites use .govA .gov website belongs to an official government organization in the United States. “The healthy heart can handle these chemicals just fine — of course, in moderation. The fragile heart may not be able to,” says Dr. Michael Ackerman, a genetic cardiologist at Mayo Clinic. Treatment focuses on treating the infection with antibiotics (if amphetamine short term and long term effects it’s bacterial) or anti-inflammatory medicines (if it’s viral). If another underlying condition is causing pleurisy, the goal of treatment will be to treat the condition. Pain relievers like Advil (ibuprofen) and getting rest can help ease the discomfort. Treatment involves using medications like Bayer (aspirin) or Advil (ibuprofen) to reduce inflammation.
Reports have indicated that ketamine, or ‘Special K’ as it is also known, is being used recreationally in the UK, Sweden, Australia, USA and many other parts of the world (Dillon et al., 2003). This rapidly spreading misuse could result in perceptual distortions, thought disorders, emotional withdrawal and ‘melting into the surrounding’. Severe addictive practices induced by ketamine abuse are difficult to control and incite abusers to progressively increase ketamine doses. More importantly, long-term use of ketamine may damage the cardiovascular system and increase the risk of sudden death (Weiner et al., 2000). Echocardiography under ketamine–xylazine anaesthesia revealed an increased left ventricular (LV) wall thickness and a decreased LV lumen diameter (Kamphoven et al., 2001). So ketamine misapplication is not only a drug abuse problem, but could also cause long-term disruption of the cardiovascular system.
Mild to moderate transient increases in blood pressure, heart rate, and cardiac output are common due to ketamine’s increase in sympathetic activity. Often this is a desirable effect of ketamine that may help to avoid peri-procedural hypotension. However, there is a concern that these physiological changes could result in an increased myocardial oxygen demand that may exacerbate underlying cardiac disease.
Still, it’s important to note the FDA has not approved ketamine as a treatment for these conditions, and it could remain that way, given that the drug is generic, and it costs a lot of money to fund large trials needed for federal approval. However, increasingly, the drug is being used off-label — often as an infusion — at outpatient clinics and in some major medical centers. Off-label use is when doctors prescribe an approved drug for an unapproved use; the Agency for Healthcare Research and Quality says the practice is both legal and common. In contrast, no recreational use of the drug is safe, as it can cause addiction and adverse health effects that can lead to death. Like any other addiction, ketamine can create a powerful bond that takes control of a person’s life.
We would like to express our gratitude to the patient for allowing us to share her clinical history in this case report. We also thank the medical staff at Staten Island University Hospital for their dedication and support in providing excellent patient care. Additionally, we appreciate the guidance and expertise provided by the cardiology department throughout the diagnostic process and treatment of this complex case.
Seeing your healthcare provider promptly is essential to determine what’s causing the pain and get the proper treatment for your health and comfort. In our case, the patient had elevated troponins along with an EF of 15% which improved in 2–4 weeks. The transient nature of acute systolic heart failure along with ruling out other possible etiologies leaves ketamine-induced heart failure as the most plausible alcohol as a seizure trigger explanation. The data on the management of ketamine induced heart failure is sparse and is mainly driven by similar case reports. Close follow-up and monitoring are required, and steps should be taken to ensure cessation of ketamine use. Ketamine is a compound with many potential benefits for the treatment of mental disorders as well as many risks, making it a “hot topic” in the field of psychiatry.