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cardio.hypertensive-emergency.methamphetamine-related.v1PRODUCTION
cardio.hypertensive-emergency.methamphetamine-related.v1

Methamphetamine / amphetamine-derivative hypertensive crisis (sustained ~12-24 h α-adrenergic + dopaminergic + serotonergic crisis with hyperthermia + agitation + meth-induced cardiomyopathy risk)

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Canonical 12-phase frame with authored status for this dossier.

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Detailed

Methamphetamine HTN crisis = α-adrenergic-driven vasoconstriction + tachycardia + dopaminergic psychosis + serotonergic hyperthermia, SUSTAINED 12-24 h (vs cocaine 1-2 h) due to ~10-12 h half-life. Pharmacology pivot: BENZODIAZEPINE FIRST for sympatholysis, often requiring sustained titration over 12-24 h (longer than cocaine); AVOID β-blocker monotherapy (unopposed alpha — Lange NEJM 1989 PMID 2522592 + AHA 2008 PMID 18391116 + AHA 2024 stimulant cardiotoxicity statement); AGGRESSIVE COOLING for hyperthermia >40°C (ice bath, evaporative, cold IV crystalloid). Route to parent engine for shared HTN-emergency arc; this dossier owns the meth-specific sustained pharmacology + meth-induced cardiomyopathy + SUD treatment.

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meth/amphetamine etiology confirmed by history or UDS

Patient inputs (14)

Most meth users 25-50 y; younger users have more agitation + hyperthermia, older have higher CV event rates + cardiomyopathy

Confirms etiology — meth (smoked/IV/snorted/ingested), Adderall supratherapeutic, MDMA, cathinones; route of use predicts onset (IV/smoked = minutes, oral/snort = 30-60 min); duration of use predicts cardiomyopathy risk

Meth-associated MI rate ~3-6% similar to cocaine in stimulant chest-pain ED visits — drives troponin + ECG cascade

STEMI pattern, ischemia, QTc prolongation (meth + MDMA prolong QT), arrhythmia (AF, VT)

Meth-associated MI rate ~3-6% in stimulant chest-pain ED visits; serial q3-6h × 2

Confirms amphetamine class (cross-reactivity with pseudoephedrine, MDMA, certain cathinones); window 1-3 d depending on metabolite + assay

Rhabdomyolysis-AKI common in meth toxidrome (often more severe than cocaine due to longer agitation/hyperthermia); drives volume resuscitation + drug dosing

Rhabdomyolysis screen — CK often >10000 in severe meth toxidrome with hyperthermia + agitation; drives aggressive IV fluids + bicarbonate decision

Meth-induced cardiomyopathy screen — global hypokinesis, often EF <40% in chronic users; differentiate Takotsubo (apical ballooning, transient) from chronic meth CMP (often partially reversible with abstinence per Schürer JACC 2017)

Defines crisis threshold; drives titration of nitroglycerin + phentolamine; meth crisis often sustained 12-24 h requiring prolonged infusion

Component of MAP; DBP >120 supports crisis criterion + alpha-overdrive severity

Sympathetic tachycardia + risk of demand ischemia + arrhythmia; meth-induced cardiomyopathy with EF <40 + tachy → demand mismatch

Hyperthermia >40°C HALLMARK of meth toxidrome (more common than with cocaine); >41°C → multi-organ failure + DIC + rhabdo cascade — drives aggressive cooling decision

Methamphetamine psychosis + agitation drives benzodiazepine titration + restraint decisions; differentiate from primary psychiatric crisis

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Severity triggers (5)

5 need judgement
  • informationallife_threateningmethamphetamine_hyperthermia_above_40c
    Core temperature >40°C in methamphetamine toxidrome — HALLMARK risk (more common than cocaine); >41°C → multi-organ failure + DIC + rhabdo cascade with very high mortality
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmeth_induced_cardiomyopathy_with_cardiogenic_shock
    Chronic meth user with new severe LV dysfunction (EF often <30%) + cardiogenic shock — meth-induced cardiomyopathy decompensation (Schürer JACC 2017 PMID 28473131)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationallife_threateningmethamphetamine_associated_stemi_or_acs
    Methamphetamine/amphetamine use within 24-48 h + STEMI on ECG OR positive troponin trajectory — meth-associated MI (rate ~3-6% in stimulant chest-pain ED visits per AHA 2024 framework)
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalseverebeta_blocker_exposure_error_in_methamphetamine_user
    Patient already received β-blocker (metoprolol/esmolol/propranolol) before meth exposure recognized — anticipate paradoxical worsening from unopposed alpha vasoconstriction
    Trigger could not be auto-evaluated — needs clinician judgement.
  • informationalsevererecurrent_methamphetamine_use_with_failed_SUD_treatment
    Recurrent meth use despite contingency management or behavioral therapy — high relapse rate; consider intensification of MAT bridge to longer-term BP regimen + cardiomyopathy progression risk
    Trigger could not be auto-evaluated — needs clinician judgement.

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Recommended regimen

Methamphetamine / amphetamine HTN crisis — sustained benzodiazepine-first sympatholysis (12-24 h), AVOID β-blocker monotherapy (unopposed alpha), aggressive cooling for hyperthermia >40°C, contingency management for long-term SUD
axis: methamphetamine_htn_crisis_pharmacology
Selected axis "Methamphetamine / amphetamine HTN crisis — sustained benzodiazepine-first sympatholysis (12-24 h), AVOID β-blocker monotherapy (unopposed alpha), aggressive cooling for hyperthermia >40°C, contingency management for long-term SUD" by default fallback (first axis)
  • lorazepam
    first line
    benzodiazepine
    1-2 mg IV q5-10 min PRN, anticipate cumulative 8-20+ mg over 12-24 h given meth half-life • IV • PRN
    triggers: methamphetamine_crisis, agitation_or_seizure_or_hyperthermia
    AHA 2008 Class I PMID 18391116 + AHA 2024 stimulant update — benzodiazepine first for sympatholysis; meth sustained crisis requires repeat dosing far longer than cocaine
    rxcui 6470
  • diazepam
    first line
    benzodiazepine
    5-10 mg IV q5-10 min • IV • PRN
    triggers: methamphetamine_crisis, agitation_seizure
    AHA 2008 — alternative to lorazepam; longer half-life (~30-100 h active metabolite) advantageous for sustained meth-related sympatholysis
    rxcui 3322
  • nitroglycerin
    second line
    organic_nitrate
    5-200 mcg/min IV titrate q3-5 min • IV • continuous
    triggers: persistent_HTN_after_benzo, meth_chest_pain_with_ischemia
    AHA 2008 Class IIa + AHA 2024 — vasodilator + coronary vasodilator; reverses meth coronary vasoconstriction; preferred over β-blocker
    rxcui 4917
  • phentolamine
    second line
    alpha_adrenergic_blocker
    1-5 mg IV q5-15 min titrate • IV • PRN bolus
    triggers: persistent_HTN_after_benzo_and_NTG, documented_coronary_vasospasm, beta_blocker_exposure_error_unopposed_alpha
    Boehrer Am J Med 1993 PMID 8390052 — pure alpha-blocker reverses meth alpha-vasoconstriction + reverses coronary vasospasm; AHA 2008 Class IIa; also rescue if β-blocker accidentally given
    rxcui 8153
  • verapamil
    second line
    non_DHP_CCB
    5-10 mg IV slow push q15-30 min OR 0.075-0.15 mg/kg • IV • PRN bolus
    triggers: meth_chest_pain_with_vasospasm, tachycardia_with_HTN
    Negus Circulation 1994 (extends to meth) — verapamil reverses stimulant coronary vasospasm; AHA 2008 Class IIa CCB acceptable
    rxcui 11170
  • diltiazem
    second line
    non_DHP_CCB
    0.25 mg/kg IV bolus then 5-15 mg/h infusion • IV • continuous
    triggers: meth_HTN_with_AF_or_tachycardia
    AHA 2008 — alternative non-DHP CCB; useful if AF + RVR
    rxcui 3443
  • labetalol
    add on
    mixed_alpha_beta_blocker
    AVOID as first-line; if used: 10-20 mg IV q10 min ONLY after alpha-blockade established with phentolamine • IV • bolus
    triggers: HTN_and_tachy_after_benzo_and_NTG_and_phento_failed_alpha_blockade_established
    AHA 2024 — labetalol is debated; mixed α/β but small β-effect may cause unopposed alpha; AVOID as first-line; add-on only AFTER alpha-blockade per AHA 2024 stimulant statement
    rxcui 6185
  • dantrolene
    comorbidity specific
    ryanodine_receptor_antagonist
    1-2.5 mg/kg IV q5-10 min, max 10 mg/kg/24h • IV • PRN
    triggers: hyperthermia_above_40c_with_NMS_or_serotonin_features, rigidity_with_hyperthermia
    For severe hyperthermia >41°C refractory to cooling + benzo, particularly if NMS-like or serotonin-syndrome overlap (MDMA + SSRI); reduces muscle hyperthermia
    rxcui 3105
  • sodium_bicarbonate
    comorbidity specific
    alkalinizer
    1-2 mEq/kg IV bolus then infusion (3 ampules in 1L D5W at 150-200 mL/h target urine pH >6.5) • IV • continuous
    triggers: rhabdomyolysis_with_CK_above_5000, wide_complex_tachycardia_meth_sodium_channel_blockade
    Urine alkalinization for rhabdo (target urine pH >6.5 reduces myoglobin tubular toxicity); also reverses meth sodium-channel blockade in wide-complex tachycardia (similar to TCA OD framework)
    rxcui 36676
  • AVOID metoprolol/esmolol/propranolol monotherapy
    contraindication substitute
    do_not_use
    AVOID • N/A • N/A
    triggers: methamphetamine_or_amphetamine_exposure
    Lange NEJM 1989 PMID 2522592 (extends to meth per AHA 2024) — propranolol potentiates stimulant coronary vasoconstriction (unopposed alpha); AHA 2008 Class III; ACC/AHA 2025 ACS Class III β-blocker monotherapy
  • AVOID succinylcholine if rhabdomyolysis
    contraindication substitute
    do_not_use
    AVOID • N/A • N/A
    triggers: rhabdomyolysis_with_hyperK
    Hyperkalemia from rhabdomyolysis + succinylcholine = arrest risk; use rocuronium for RSI
  • AVOID haloperidol monotherapy for meth agitation
    contraindication substitute
    do_not_use
    AVOID • N/A • N/A
    triggers: methamphetamine_agitation_with_hyperthermia
    Antipsychotics impair thermoregulation + lower seizure threshold + may worsen hyperthermia in meth toxidrome; benzodiazepine is first-line for agitation per AHA 2024

outpatient playbook — drug actions (5)

  1. 1. continue HTN regimen
    rxcui 17767
    Amlodipine 5-10 ± lisinopril ± chlorthalidone • PO • daily
    trigger: Stable maintenance
    ACC/AHA 2025
  2. 2. continued GDMT for meth cardiomyopathy
    rxcui 20352
    Carvedilol 6.25-25 mg BID + sacubitril-valsartan + spironolactone + empagliflozin • PO • BID + daily
    trigger: Meth cardiomyopathy + EF <40
    Schürer JACC 2017 + standard 4-pillar HFrEF GDMT — partial reversibility documented with sustained abstinence
  3. 3. beta-blocker for cardio-protection if MI history + abstinence
    rxcui 20352
    Carvedilol 6.25-25 mg BID titrate • PO • BID
    trigger: Post-MI + confirmed abstinence × ≥2 wk
    CAPRICORN PMID 11356436 + AHA 2024 acceptable post-clearance
  4. 4. continue MOUD if OUD
    rxcui 7242
    Per protocol • PO/SL • daily
    trigger: OUD
    Long-term MAT
  5. 5. mirtazapine or naltrexone-bupropion combo for ongoing meth SUD
    rxcui 15996
    Per Trivedi NEJM 2021 / Coffin 2020 protocols • PO • daily
    trigger: Meth use disorder
    Trivedi NEJM 2021 PMID 33497547 + Coffin JAMA Psychiatry 2020 PMID 32049330 — modest benefit, off-label

Auto-drafted A&P note

outpatient

Subjective

- Possible entry pathways: Methamphetamine, amphetamine derivative (Adderall supratherapeutic, MDMA/"ecstasy", cathinone/"bath salts"), or methylphenidate overdose within 24-48 h + SBP ≥180 / DBP ≥120 (AHA 2024 stimulant cardiotoxicity statement; Westover Circulation 2007 PMID 17646584); HTN + tachycardia + hyperthermia (often >40°C) + agitation + hallucinations + dilated pupils + diaphoresis — sustained 12-24 h methamphetamine toxidrome (vs cocaine 1-2 h); New severe LV dysfunction (often global hypokinesis, EF <40%) on echo in chronic meth user — meth-induced cardiomyopathy (Schürer JACC 2017 PMID 28473131).

Objective

- No vitals, labs, or imaging entered for this encounter.

Assessment

**Methamphetamine / amphetamine-derivative hypertensive crisis (sustained ~12-24 h α-adrenergic + dopaminergic + serotonergic crisis with hyperthermia + agitation + meth-induced cardiomyopathy risk)** (cardio.hypertensive-emergency.methamphetamine-related.v1).
Scope: Methamphetamine HTN crisis = α-adrenergic-driven vasoconstriction + tachycardia + dopaminergic psychosis + serotonergic hyperthermia, SUSTAINED 12-24 h (vs cocaine 1-2 h) due to ~10-12 h half-life. Pharmacology pivot: BENZODIAZEPINE FIRST for sympatholysis, often requiring sustained titration over 12-24 h (longer than cocaine); AVOID β-blocker monotherapy (unopposed alpha — Lange NEJM 1989 PMID 2522592 + AHA 2008 PMID 18391116 + AHA 2024 stimulant cardiotoxicity statement); AGGRESSIVE COOLING for hyperthermia >40°C (ice bath, evaporative, cold IV crystalloid). Route to parent engine for shared HTN-emergency arc; this dossier owns the meth-specific sustained pharmacology + meth-induced cardiomyopathy + SUD treatment.

No severity triggers fired against current inputs.

Plan

Regimen axis: **Methamphetamine / amphetamine HTN crisis — sustained benzodiazepine-first sympatholysis (12-24 h), AVOID β-blocker monotherapy (unopposed alpha), aggressive cooling for hyperthermia >40°C, contingency management for long-term SUD**.
1. lorazepam 1-2 mg IV q5-10 min PRN, anticipate cumulative 8-20+ mg over 12-24 h given meth half-life IV PRN (benzodiazepine, first line) — AHA 2008 Class I PMID 18391116 + AHA 2024 stimulant update — benzodiazepine first for sympatholysis; meth sustained crisis requires repeat dosing far longer than cocaine
2. diazepam 5-10 mg IV q5-10 min IV PRN (benzodiazepine, first line) — AHA 2008 — alternative to lorazepam; longer half-life (~30-100 h active metabolite) advantageous for sustained meth-related sympatholysis
3. nitroglycerin 5-200 mcg/min IV titrate q3-5 min IV continuous (organic_nitrate, second line) — AHA 2008 Class IIa + AHA 2024 — vasodilator + coronary vasodilator; reverses meth coronary vasoconstriction; preferred over β-blocker
4. phentolamine 1-5 mg IV q5-15 min titrate IV PRN bolus (alpha_adrenergic_blocker, second line) — Boehrer Am J Med 1993 PMID 8390052 — pure alpha-blocker reverses meth alpha-vasoconstriction + reverses coronary vasospasm; AHA 2008 Class IIa; also rescue if β-blocker accidentally given
5. verapamil 5-10 mg IV slow push q15-30 min OR 0.075-0.15 mg/kg IV PRN bolus (non_DHP_CCB, second line) — Negus Circulation 1994 (extends to meth) — verapamil reverses stimulant coronary vasospasm; AHA 2008 Class IIa CCB acceptable
6. diltiazem 0.25 mg/kg IV bolus then 5-15 mg/h infusion IV continuous (non_DHP_CCB, second line) — AHA 2008 — alternative non-DHP CCB; useful if AF + RVR
7. labetalol AVOID as first-line; if used: 10-20 mg IV q10 min ONLY after alpha-blockade established with phentolamine IV bolus (mixed_alpha_beta_blocker, add on) — AHA 2024 — labetalol is debated; mixed α/β but small β-effect may cause unopposed alpha; AVOID as first-line; add-on only AFTER alpha-blockade per AHA 2024 stimulant statement
8. dantrolene 1-2.5 mg/kg IV q5-10 min, max 10 mg/kg/24h IV PRN (ryanodine_receptor_antagonist, comorbidity specific) — For severe hyperthermia >41°C refractory to cooling + benzo, particularly if NMS-like or serotonin-syndrome overlap (MDMA + SSRI); reduces muscle hyperthermia
9. sodium_bicarbonate 1-2 mEq/kg IV bolus then infusion (3 ampules in 1L D5W at 150-200 mL/h target urine pH >6.5) IV continuous (alkalinizer, comorbidity specific) — Urine alkalinization for rhabdo (target urine pH >6.5 reduces myoglobin tubular toxicity); also reverses meth sodium-channel blockade in wide-complex tachycardia (similar to TCA OD framework)
10. AVOID metoprolol/esmolol/propranolol monotherapy AVOID N/A N/A (do_not_use, contraindication substitute) — Lange NEJM 1989 PMID 2522592 (extends to meth per AHA 2024) — propranolol potentiates stimulant coronary vasoconstriction (unopposed alpha); AHA 2008 Class III; ACC/AHA 2025 ACS Class III β-blocker monotherapy
11. AVOID succinylcholine if rhabdomyolysis AVOID N/A N/A (do_not_use, contraindication substitute) — Hyperkalemia from rhabdomyolysis + succinylcholine = arrest risk; use rocuronium for RSI
12. AVOID haloperidol monotherapy for meth agitation AVOID N/A N/A (do_not_use, contraindication substitute) — Antipsychotics impair thermoregulation + lower seizure threshold + may worsen hyperthermia in meth toxidrome; benzodiazepine is first-line for agitation per AHA 2024

Setting playbook (outpatient) — Long-term cardiology + addiction medicine + PCP coordination — sustained SUD remission, BP <130/80, secondary prevention if MI history, meth cardiomyopathy reversibility assessment at 3-12 mo, harm reduction for relapse
13. continue HTN regimen Amlodipine 5-10 ± lisinopril ± chlorthalidone PO daily — Stable maintenance (ACC/AHA 2025)
14. continued GDMT for meth cardiomyopathy Carvedilol 6.25-25 mg BID + sacubitril-valsartan + spironolactone + empagliflozin PO BID + daily — Meth cardiomyopathy + EF <40 (Schürer JACC 2017 + standard 4-pillar HFrEF GDMT — partial reversibility documented with sustained abstinence)
15. beta-blocker for cardio-protection if MI history + abstinence Carvedilol 6.25-25 mg BID titrate PO BID — Post-MI + confirmed abstinence × ≥2 wk (CAPRICORN PMID 11356436 + AHA 2024 acceptable post-clearance)
16. continue MOUD if OUD Per protocol PO/SL daily — OUD (Long-term MAT)
17. mirtazapine or naltrexone-bupropion combo for ongoing meth SUD Per Trivedi NEJM 2021 / Coffin 2020 protocols PO daily — Meth use disorder (Trivedi NEJM 2021 PMID 33497547 + Coffin JAMA Psychiatry 2020 PMID 32049330 — modest benefit, off-label)

Non-pharmacologic actions:
- Sustained engagement in addiction medicine + contingency management
- Naloxone refilled
- Cardiac rehab if MI history or meth cardiomyopathy
- Annual cardiology follow-up

AVOID / contraindication checks:
- Beta_blocker_monotherapy_avoid_in_methamphetamine_or_amphetamine (AHA 2008 PMID 18391116 + AHA 2024 stimulant cardiotoxicity update)
- Propranolol_potentiates_meth_coronary_vasoconstriction (Lange NEJM 1989 PMID 2522592 extension)
- Succinylcholine_avoid_with_rhabdomyolysis_hyperK
- Haloperidol_avoid_monotherapy_for_meth_agitation_use_benzo (AHA 2024)
- Thrombolytics_caution_in_meth_HTN_due_to_ICH_risk_prefer_PCI (AHA 2008 + AHA 2024)
- Benzo_first_then_NTG_then_phentolamine_then_CCB_anticipate_sustained_dosing_12_24h (AHA 2008 + AHA 2024 algorithm extended for meth half life)
- Cool_aggressively_if_temp_above_40c_within_30_min (high mortality if delayed)

Monitoring

Regimen monitoring:
- continuous ECG q15min BP minimum 24h (AHA 2008 + AHA 2024)
- serial troponin q3-6h x2 (Hollander NEJM 2008 PMID 18172180 framework extension)
- serial ECG q4h x24h (AHA 2008)
- CK q6h until trending down if rhabdomyolysis suspected
- temperature q15-30min with active cooling if >40C
- mental status and agitation assessment q1h
- UOP target >1-2mL/kg/h if rhabdomyolysis
- urine pH target >6.5 if bicarb alkalinization
- echo at 3-6 months for meth cardiomyopathy reversibility assessment with abstinence (Schürer JACC 2017)

Setting (outpatient) monitoring:
- Quarterly BP + addiction visit
- Annual ECG + lipid + A1c
- Serial echo (3-6-12 mo) for meth cardiomyopathy reversibility

Follow-up plan: Substance use disorder counseling + treatment — CONTINGENCY MANAGEMENT has strongest RCT evidence for meth use disorder (Connors Annu Rev Clin Psychol 2018 PMID 29494256); no FDA-approved MAT for meth (mirtazapine + naltrexone-bupropion combo modest benefit per Trivedi NEJM 2021 PMID 33497547 + Coffin JAMA Psychiatry 2020 PMID 32049330); cardiology follow-up if MI/Takotsubo/cardiomyopathy occurred; ECHO at 3-6 months to assess for meth cardiomyopathy reversibility with abstinence (Schürer JACC 2017 — partial reversibility documented); BP regimen if persistent HTN; opioid agonist therapy if fentanyl-laced supply suspected; harm reduction; HIV/HCV screening; PrEP discussion if applicable
- Close-out criterion: SUD treatment booked (contingency management + behavioral therapy) + cardiology follow-up + BP regimen if needed + harm reduction + repeat echo at 3-6 mo if cardiomyopathy

Monitoring phase: Continuous ECG + telemetry; q15-30 min BP; serial troponin q3-6h × 2; CK q6h if rhabdomyolysis; UOP target >1-2 mL/kg/h; mental status + agitation scale q1h; temp q15-30 min if hyperthermic

Disposition

Current setting: outpatient — Long-term cardiology + addiction medicine + PCP coordination — sustained SUD remission, BP <130/80, secondary prevention if MI history, meth cardiomyopathy reversibility assessment at 3-12 mo, harm reduction for relapse

Disposition criteria:
- Long-term continuation; cross-link to cardio.htn.core.v1 + cardio.hf.core.v1 (if cardiomyopathy persists) + addiction medicine for chronic management

Escalation triggers (move to higher acuity):
- Relapse with chest pain → ED
- BP rebound → urgent visit
- HF decompensation → cardiology urgent

Earlier-Return Triggers

Return-precaution thresholds (watch for):
- [LIFE_THREATENING] Core temperature >40°C in methamphetamine toxidrome — HALLMARK risk (more common than cocaine); >41°C → multi-organ failure + DIC + rhabdo cascade with very high mortality
- [LIFE_THREATENING] Chronic meth user with new severe LV dysfunction (EF often <30%) + cardiogenic shock — meth-induced cardiomyopathy decompensation (Schürer JACC 2017 PMID 28473131)
- [LIFE_THREATENING] Methamphetamine/amphetamine use within 24-48 h + STEMI on ECG OR positive troponin trajectory — meth-associated MI (rate ~3-6% in stimulant chest-pain ED visits per AHA 2024 framework)

Citations

- AHA 2024 Stimulant Cardiotoxicity Scientific Statement (Manja Circulation 2024) + AHA 2008 Cocaine Cardiovascular Complications (McCord PMID 18391116) extended to methamphetamine + 2025 ACC/AHA HTN (Whelton) [PMID:18391116](https://pubmed.ncbi.nlm.nih.gov/18391116/)
- Cited evidence (PMID 28473131) [PMID:28473131](https://pubmed.ncbi.nlm.nih.gov/28473131/)
- Cited evidence (PMID 17646584) [PMID:17646584](https://pubmed.ncbi.nlm.nih.gov/17646584/)
- Cited evidence (PMID 29494256) [PMID:29494256](https://pubmed.ncbi.nlm.nih.gov/29494256/)
- Cited evidence (PMID 33497547) [PMID:33497547](https://pubmed.ncbi.nlm.nih.gov/33497547/)

Last reconciled with current guidelines: 2026-05-15.
References
  • AHA 2024 Stimulant Cardiotoxicity Scientific Statement (Manja Circulation 2024) + AHA 2008 Cocaine Cardiovascular Complications (McCord PMID 18391116) extended to methamphetamine + 2025 ACC/AHA HTN (Whelton) — PMID:18391116
  • Cited evidence (PMID 28473131) — PMID:28473131
  • Cited evidence (PMID 17646584) — PMID:17646584
  • Cited evidence (PMID 29494256) — PMID:29494256
  • Cited evidence (PMID 33497547) — PMID:33497547