HJBR Nov/Dec 2022

HEALTHCARE JOURNAL OF BATON ROUGE I  NOV / DEC 2022 29 treatment, a common obstacle amongst drug users, further complicates management. The standard of care nowadays for the treatment of myocardial infarction due to an occluded vessel is implantation of a coronary stent. Af- ter restoration of flow in the vessel by inflat- ing a coronary balloon within an obstruction, implanting a coronary stent maintains vessel patency. However, coronary stents require ad- herence to medications such as blood thin- ners. In fact, without blood thinners, it is not clear whether the patient has a better progno- sis without a stent. Opiates such as morphine and fentanyl, as well as heroin, have a different impact on the body. They can increase the parasympathetic nervous system’s activity by changing the bal- ance with the reduced sympathetic nervous system’s activity. This results in a low heart rate (bradycardia) and hypotension (low blood pressure). In addition, they may cause respira- tory depression and damage to the lungs. A major concern of IV drug use is the develop- ment of infections in the heart. Typically, intra- venous drug users (IVDUs) develop infections on the tricuspid valve, which is located on the right side of the heart and separates the right heroin is considered, according to the Great- er New Orleans Situational Drug Report, the greatest drug threat to the greater NO area. The report is based on surveys amongst first responders and identifies drug trends within the NO metropolitan area. The prevalence of drug use among home- less people is particularly high. In 2020, NO’s homeless population grew for the first time in over a decade, partly due to the COV- ID-19 pandemic, and in 2021, there were 2,131 homeless persons in Louisiana and 560 home- less persons in Orleans and Jefferson Parish. These numbers are an underestimation be- cause unsheltered homeless persons are not included, and the real number probably sur- passes 3,000 in Louisiana and 1,300 in Orleans and Jefferson Parish. EFFECTS OF DRUG USE ON THE HEART The various drugs have different effects on the body, and specifically on the heart. They may cause hypertension (acute or chronic) or in some cases very low blood pressure, chest pain and heart attack, arrhythmias, infections, aortic dissection, and sudden death. Stimulants such as cocaine and amphet- amines activate the sympathetic nervous sys- tem by increasing the availability of substanc- es, including norepinephrine, dopamine, and serotonin, in nerve terminals. Activating the sympathetic nervous system leads to tachy- cardia (increased heart rate), vasoconstriction (narrowing of vessels), and fluctuation in blood pressure. One of the major hazards with drug abuse is the additional substances that are mixed with the drug. Different toxins can have a direct impact on the heart muscle and dam- age blood vessels. Together with the patho- physiological effects of the drug, myocardial ischemia (mismatch between the blood sup- ply and demand of the heart muscle) and con- tractile depression may occur. Spasm of blood vessels and blood-clot formation due to injury to the endothelial cells, which line the internal layer of the vessels, lead to myocardial infarc- tion (heart attack). Noncompliance to medical atrium and the right ventricle. Bacteria enter the blood stream through the injection site or along with the injected material and flow to- ward the tricuspid valve, causing infective en- docarditis (IE). IE is an insidious disease that presents with vague symptoms such as fever, malaise, fatigue, rash, and ill-defined aches or joint pain. Additional signs and symptoms result from emboli from the infection pro- cess, i.e., dislodged particles that occlude the blood supply of various other organs as well as spread the infection. Without treatment, mortality is almost inev- itable with IE. Even with antibiotic treatment, mortality rates remain high. With the home- less population and IVDUs, treatment is fur- ther hindered by noncompliance and the late presentation in the course of the disease. Pa- tients may develop a large mass on the tricus- pid valve, termed vegetation. The vegetation is composed mostly of the bacteria, inflam- matory material, and thrombi. Large vegeta- tion impedes penetration of antibiotics, and, along with the biofilm that certain bacteria produce, the response to treatment is lowered and sometimes nonexistent. Patients may die of heart failure due to insufficiency of the valve “One of the major hazards with drug abuse is the additional substances that are mixed with the drug. Different toxins can have a direct impact on the heart muscle and damage blood vessels.”