Heart damage occurs when substances or medical conditions harm heart tissue. Signs of heart damage from drugs may include chest pain, irregular heartbeat, and cough.

Substances can affect the cells of the heart in different ways. Some mechanisms that explain how certain drugs can cause heart damage include changing how the heart cell contracts and killing heart cells.

Fortunately, preventing heart damage from drugs is possible. Depending on the drug that caused heart failure, people can sometimes reverse heart failure.

This article provides an overview of signs of heart damage from drugs.

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Signs of heart damage from drugs can vary between substances. Various signs of heart damage from drugs include:

  • arrhythmia, or abnormally fast or slow heart rhythm
  • lack of blood and oxygen supply to the heart
  • cardiomyopathy, or diseases of the heart muscles
  • ineffective heart muscle cell contraction
  • heart muscle cell death

Anyone experiencing these symptoms should seek urgent medical assistance.

These changes to heart function may cause a person to experience several different symptoms including:

Drug-induced heart failure occurs when a substance changes how the heart functions, or causes enough physical damage.

The toxic effects of drugs on the heart can cause cell death, reduced muscle cell contractions, and changes in heart rate. Drug-induced heart failure can occur when drugs affect blood vessels, impairing blood flow to and from the heart.

Drugs can cause high or low blood pressure, blood clots that can travel anywhere in the body, and stroke.

These vascular effects can be a consequence or a cause of drug-induced heart failure. Vascular effects, like high blood pressure, feed back to the heart and can cause further damage.

Experts have identified many substances that are toxic to the heart. Certain prescription drugs and illicit substances can directly induce or increase the risk of heart damage.

Group of drugsAffect on the heart
Nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil)
naproxen (Aleve)		NSAIDs and selective COX-2 inhibitors can increase the levels of sodium and water in the blood. This puts stress on the heart and the blood vessels. People with heart failure symptoms, or history, should always stay away from NSAIDs.
Anthracyclines daunorubicin (Cerubidine)
mitoxantrone		The group of anticancer drugs called anthracyclines cause and worsen heart damage through long-term oxidative stress. Oxidative stress can damage cells and cause problems with how heart cell functions. These effects are irreversible, and the risk increases with higher doses.
Thiazolidinediones
pioglitazone (Actos)
rosiglitazone (Avandia)		Thiazolidinediones can cause water retention and weight gain. This can worsen heart failure or increase the risk of developing heart failure.
Stimulants cocaine
methylphenidate (Ritalin)
atomoxetine (Strattera)		Stimulants can cause heart failure by increasing blood pressure and directly damaging cells in the heart.

Drugs can be toxic to the heart through many different mechanisms. These mechanisms cause different types of heart damage.

For some drugs, experts still do not know the mechanism explaining how they cause heart failure. Examples of drugs that have no known mechanism include:

  • the antifungal medication Amphotericin B
  • the cancer drugs 5-fluorouracil (Adrucil) and capecitabine (Xeloda)
  • the Parkinson’s drug pramipexole (Mirapex)

Damage to the heart can cause a failure on the left side, right side, or both simultaneously.

Left-sided heart failure or damage

Damage to the left side of the heart impairs its ability to pump blood efficiently to the body. When this occurs, the heart must work harder to ensure vital organs receive adequate blood supply, putting strain on the heart muscles.

Right-sided heart failure or damage

Right-sided heart failure often occurs due to failure on the left side.

Damage to the right side of the heart means it cannot move deoxygenated blood to the lungs efficiently. This can cause blood to build up in the veins supplying the right side of the heart. This can lead to swelling in the lower limbs, abdomen, and organs.

Systolic or diastolic heart failure

Drug-induced damage can impair heart muscle functions in two main ways.

  • Systolic heart failure: In systolic heart failure, heart muscles cannot contract as necessary. This reduces the heart’s ability to pump blood to the rest of the body.
  • Diastolic heart failure: In diastolic heart failure the heart muscles stiffen. This means ventricles cannot fill with blood as they should.

Treating heart damage from drugs most often requires stopping the drug from causing problems.

Treating heart damage from drugs depends on the developed heart condition. For example, a person who has a heart attack from having an overdose of cocaine requires an initial treatment with a benzodiazepine drug such as lorazepam (Ativan).

Other treatment options will depend on the severity of a person’s heart damage. These may include:

A person’s outlook will depend on the severity of heart damage they sustain.

Stopping the intake of drugs causing heart damage, making positive lifestyle changes, and following treatment plans can stop damage from worsening, and help people improve their quality of life. However, damage to heart muscles from heart attacks and heart failure is permanent.

In cases of heart failure, people will typically require a degree of treatment for the rest of their life.

When it comes to drug-induced heart failure, prevention is key. Different medical professionals, like doctors, pharmacists, nurses, and poison specialists, can help prevent drug-induced heart failure.

Other prevention strategies include avoiding:

Drug-induced heart failure is a broad disease because of the many ways drugs can damage the heart. Likewise, signs of heart damage from drugs depend on a person’s medical history and the specific drug. Some drugs directly damage the heart while others cause heart failure because of their effect on blood vessels.