Open Access Open Access  Restricted Access Subscription or Fee Access

Torsades-de-Pointes associated with Taku-Tsubo cardiomyopathy following greatly reduced oxycodone use in an elderly woman

Harry W. Daniell, MD

Abstract


This article reports an elderly female oxycodone consumer who developed Torsades-de-Pointes soon after her opioid-associated rate-corrected QT interval (QTC; a standard measurement on electrocardiograms) prolongation had been augmented by the development of Taku-Tsubo cardiomyopathy (TC), a sequence that followed greatly reduced oxycodone ingestion. Factors that likely contributed to this sequence are discussed, including direct opioid-induced inhibition of human ether-a-go-go-related gene activity and of androgen formation plus QTc prolongation induced by the presence of TC.

Keywords


Taku-Tsubo cardiomyopathy, Torsades-de-Pointes, sustained-action oxycodone, internal potassium rectifier channel, human ether-a-go-go-related-gene

Full Text:

PDF

References


Krantz M, Lewkowiez, L, Hays H, et al.: Torsades-de-pointes associated with very-high dose methadone. Ann Intern Med. 2002; 137: 501-504.

Ehret GB, Voide C, Gex-Fabry M, et al.: Drug-induced long QT syndrome in injection drug users receiving methadone: High frequency in hospitalized patients and risk factors. Arch Intern Med. 2006; 166: 1280-1287.

Wedam EF, Bigelow GE, Johnson RE, et al.: QT-interval effects of methadone, levomethadyl, and buprenorphine in a randomized trial. Arch Intern Med. 2007; 167: 2469-2475.

Fanoe S, Jensen G, Sjogren P, et al.: Oxycodone is associated with dose-dependent QTc prolongation in patients and low-affinity inhibiting of hERG activity in vitro. Br J Clin Pharmacol. 2009; 67: 172-179.

Andrews C, Krantz M, Wedam E, et al.: Methadone-induced mortality in the treatment of chronic pain: Role of QT prolongation. Cardiol J. 2009; 16: 210-217.

Wieneke H, Conrads H, Wolstein J, et al.: Levo-alpha-acetylmethadol (LAAM) induced QTc-prolongation-results from a controlled clinical trial. Eur J Med Res. 2009; 14: 7-12.

Deamer RL, Wilson DR, Clark DS, et al.: Torsades-de-pointes associated with high dose levomethadyl acetate (ORLAAM). J Addict Dis. 2001; 20: 7-14.

Pilgrim T, Wyss T: Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review. Int J Cardiol. 2008; 124: 283-292.

Samuelov-Kinori L, Kinori M, Kogan Y, et al.: Takotsubo cardiomyopathy and QT interval prolongation: Who are the patients at risk for torsades-de-pointes? J Electrocardiol. 2009;42: 353-357.

Bidoggia H, Maciel J, Capalozza N, et al.: Sex differences on the electrocardiographic pattern of cardiac repolarization: Possible role of testosterone. Am Heart J. 2000; 140: 678-683.

Fulop L, Bayasz T, Szabo G, et al.: Effects of sex hormones on ECG parameters and expression of cardiac channels in dogs. Acta Physiol. 2006; 188: 163-171.

Matsuoka K, Okubo S, Fujii E, et al.: Evaluation of the arrhythmogenecity of stress-induced “Takotsubo cardiomyopathy” from the time course of the 12-lead surface electrocardiogram. Am J Cardiol. 2003; 92: 230-233.

Rivera J, Locketz A, Fritz K, et al.: “Broken heart syndrome” after separation (from oxycontin). Mayo Clin Proc. 2006; 81: 825-828.

Lemesle F, Lemesle F, Nicola W, et al. First case of stress cardiomyopathy as a result of methadone withdrawal secondary to drug-drug interaction. Am J Emerg Med. 2010;28:387. e5-387.e6.

Katchman AN, McGroary KA, Kilborn MJ, et al.: Influence of opioid agonists on cardiac human ether-a-go-go-related gene K (+) currents. J Pharmacol Exp Ther. 2002; 303: 688-694.

Daniell HW: Opioid endocrinopathy in women consuming prescribed sustained-action opioids for control of nonmalignant pain. J Pain. 2008; 9: 28-36.

Daniell H: Hypogonadism in men consuming sustained-action oral opioids. J Pain. 2002; 3: 377-384.

Bliesener N, Albrecht S, Schwager A, et al.: Plasma testosterone and sexual function in men receiving buprenorphine maintenance for opioid dependence. J Clin Endocrinol Metab. 2005; 90: 203-206.

James A, Hancox J: Sex, drugs and arrhythmia: Are gender differences in risk of torsades-de-pointes simply a matter of testosterone? Cardiovasc Res. 2003; 57: 1-4.




DOI: https://doi.org/10.5055/jom.2011.0058

Refbacks

  • There are currently no refbacks.