Cardiovascular Complications of Opioid Use: JACC State-of-the-Art Review

Mori J. Krantz*, Robert B. Palmer, Mark C.P. Haigney

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

56 Scopus citations


Opioids are the most potent of all analgesics. Although traditionally used solely for acute self-limited conditions and palliation of severe cancer-associated pain, a movement to promote subjective pain (scale, 0 to 10) to the status of a “fifth vital sign” bolstered widespread prescribing for chronic, noncancer pain. This, coupled with rising misuse, initiated a surge in unintentional deaths, increased drug-associated acute coronary syndrome, and endocarditis. In response, the American College of Cardiology issued a call to action for cardiovascular care teams. Opioid toxicity is primarily mediated via potent μ-receptor agonism resulting in ventilatory depression. However, both overdose and opioid withdrawal can trigger major adverse cardiovascular events resulting from hemodynamic, vascular, and proarrhythmic/electrophysiological consequences. Although natural opioid analogues are devoid of repolarization effects, synthetic agents may be proarrhythmic. This perspective explores cardiovascular consequences of opioids, the contributions of off-target electrophysiologic properties to mortality, and provides practical safety recommendations.

Original languageEnglish
Pages (from-to)205-223
Number of pages19
JournalJournal of the American College of Cardiology
Issue number2
StatePublished - 19 Jan 2021
Externally publishedYes


  • QT-prolongation
  • arrhythmia
  • dextromethorphan
  • endocarditis
  • hERG channel
  • levacetylmethadol
  • loperamide
  • methadone
  • mortality
  • opioid mortality
  • opioid overdose
  • opioid withdrawal
  • opioids
  • propoxyphene
  • torsade de pointes


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