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Ketamine-induced ventricular structural, sympathetic and electrophysiological remodelling: pathological consequences and protective effects of metoprolol PMC

can ketamine cause a heart attack

Overall, the patients received a median dose of 0.57 mg/kg of ketamine. In the ischemia group, the median dose was higher than the milligram per kilogram dosing of the non-ischemia group (0.84 vs. 0.56). One patient in the ischemia group had been enrolled in this study previously on a separate patient encounter. Given their relative hemodynamic stability, ketamine and etomidate are commonly chosen anesthetic agents for sedation during the endotracheal intubation of critically ill patients.

can ketamine cause a heart attack

Common dosing for ketamine when given intravenously for procedural sedation ranges from 0.25 mg/kg to 1 mg/kg, depending on if other anesthetic and/or analgesic medications are concomitantly administered. Unlike other types of hallucinogen drugs, the brain develops a tolerance for ketamine at a rapid rate. This means a ketamine abuse problem can easily spin out of control when using this drug on a repeated basis. Under these conditions, the risk of going into cardiac arrest increases exponentially.

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The extra work done by the heart eventually starts to damage the cells and tissues that make up the heart muscle. This condition will continue to worsen with ongoing ketamine abuse. As alcohol and seizures can alcohol or withdrawal trigger a seizure the heart’s functional capacity weakens, the likelihood of cardiac arrest increases. As noted previously, each patient in the study received dose as part of their procedural sedation.

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. Ketamine remains a safe medication option in adults undergoing procedural sedation. Metoprolol prevented the cardiotoxicity of ketamine, indicating a promising new therapeutic strategy. It is also notable that all of the patients who experienced ischemia were females. PARP is a protein involved with a series of cellular processes including DNA repair and programmed cell death, cardiac hypertrophy and fibrosis. We observed that after chronic treatment with ketamine, PARP-1 expression was significantly elevated, suggesting its role in ketamine-induced apoptosis and fibrosis.

It is important to note that ketamine is no longer safe when individuals take it inappropriately. The danger increases with regular use since it can harm health and other aspects of life. In contrast, no recreational use of the drug is safe, as it can cause know the difference between ethanol and alcohol addiction and adverse health effects that can lead to death. While ketamine is safe to use in controlled medical practice, it becomes hazardous if someone takes it for recreational use as it may result in potentially life-threatening adverse effects.

  1. In comparison, the epicardia of the control animals were smooth and pink.
  2. Do not disregard or avoid professional medical advice due to content published within Cureus.
  3. This process enables the brain and body to communicate with one another on a continuous basis.
  4. The drug is a Schedule III non-narcotic that the Food and Drug Administration (FDA) has approved for use only as a general anesthetic.
  5. Aside from the above drug interactions, a 2017 study reports that taking ketamine with amphetamine-like stimulants can produce undesirable effects.

All sedations had a nurse present for the sedation and a physician responsible for monitoring the patient separate from the procedural physician. All patients received continuous monitoring of blood pressure, heart rate, oxygen saturation, and end-tidal CO2. Although these reactions can be quickly treated with a benzodiazepine, hypertension and tachycardia are often seen during these episodes, the irrational mind of addicts and alcoholics along with hallucinations and panic. This can cause an increase in oxygen consumption, as well, that could attribute to observed cardiac effects, specifically in patients with underlying cardiac disease [4-6]. Three rats (30%) in the ketamine group died at day 45, 50 and 52 of drug administration, while all rats survived through the entire procedure in the other three groups.

Does Ketamine Cause Cardiac Arrest?

This was due to random chance and not due to specific patient selection. Post-ketamine vital signs showed a notable change in 29% (9/31) of initial readings and 71% (22/31) of readings at any point during the sedation. 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 selected to receive ketamine based on provider discretion. Patients were offered enrollment after sedation choice was made by the treating provider, and informed consent was obtained if patients agreed to enrollment.

Consent was obtained during 33 independent patient encounters, and two patients were removed from the study after enrollment. The subjects were removed due to a change in sedation medication or the decision to forego procedural sedation. There were 31 ECGs included in the final evaluation, with two patients enrolled on subsequent visits. The overall study cohort had a median age of 63 years, with orthopedic manipulation as the most common indication for sedation (Table 2). Of note, all patients who consented to study enrollment were White.

Clinically significant vital sign change was defined as an increase or decrease of greater than or equal to 20% from baseline. The Charlson Comorbidity Index (CCI) was used to assess health status. The CCI predicts the 10-year survival in patients with multiple comorbidities. The incidence of myocardial ischemia following ketamine administration is unknown.

Long-Term Effects

Ketamine was not required to be the sole agent used and could be administered with other sedating and analgesic agents. Patients were eligible for enrollment during each visit in the study period. 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. A major limitation of the study was the use of a convenience sample to recruit subjects.

The drug is a Schedule III non-narcotic that the Food and Drug Administration (FDA) has approved for use only as a general anesthetic. However, doctors sometimes prescribe it for “off-label” uses, such as depression. Off-label means using the drugs to treat conditions the FDA has not approved.

The content published in Cureus is the result of clinical experience and/or research by independent individuals or organizations. Cureus is not responsible for the scientific accuracy or reliability of data or conclusions published herein. All content published within Cureus is intended only for educational, research and reference purposes. Additionally, articles published within Cureus should not be deemed a suitable substitute for the advice of a qualified health care professional. Do not disregard or avoid professional medical advice due to content published within Cureus.

However, it was not a requirement for ketamine to be the sole sedating agent during the sedation. Other agents, including propofol, opioid analgesics, and anti-emetics, specifically ondansetron, were administered during the procedural sedations at the discretion of the treating provider (Figure 1). Sedation protocol was decided by the physician primarily managing patient’s care and was not influenced by the research team.

Rats in the control and metoprolol alone groups gained weight steadily, while the ketamine-treated rats appeared to have thin, brittle and dull fur. In addition, they were emotionally unstable, more aggressive and easily became anxious. Ketamine-treated rats co-administered metoprolol were in a better state of nutrition and more stable emotionally than those treated only with ketamine. Some side effects of ketamine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine.

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