How do Opioids affect the Heart?

How do opioids affect the heart?

While the many harmful effects of opioids have become evident through the everlasting opioid crisis, some risks aren’t discussed or very well known by the public and across medical fields. Some of these factors include the way opioids can impact cardiovascular health in illicit drug users and patients who take opioid medication long-term for chronic pain.

Conditions that affect the heart most associated with opioid use include:

Atrial fibrillation is a condition that causes rapid and irregular heartbeat caused by a disrupted and fractioned electrical signal in the atria, commonly known as the upper cardiac chambers of the heart. This disorder has been observed more frequently in people who use opioids and can increase the risk of stroke and possibly heart attacks.

Bradycardia is a diagnosis commonly seen in those who take opioids and is associated with slow heart rate caused by a slowing of the sinus node, also seen in sick sinus syndrome. Bradycardia caused by opioids doesn’t often present itself while the patient is at rest, but it leads to poor cardio endurance making exercise and physical activity difficult.

Cardiovascular death or a fatal heart-related medical event unrelated to overdose is not uncommon among opioid users. A study published in 2016 showed that patients who take opioids for chronic pain unrelated to terminal illnesses such as cancer had a noticeable increase in non-overdose cardiovascular mortality. This means patients are more likely to suffer from undiagnosed heart conditions or events such as heart arrhythmias and heart attacks causing sudden death. Many experts link this to chronic opioid use and its depressive effect on breathing, leading to sleep disorders such as sleep apnea, which significantly strain the heart.

Depressed heart muscle function can erode vital cardiovascular mechanisms. Opioids, when used alone, don’t do much to prevent the heart muscle from contracting to pump blood, but when mixed with other substances such as benzodiazepines, it can lead to eventual heart failure. This is important to note since many patients who take opioids long-term for chronic pain are also prescribed medications that contain benzodiazepines such as Valium. If combined with an underlying heart condition, the heart’s function can be severely impaired.

Infective endocarditis is a life-threatening infection that affects the heart’s structures, including valves that control blood flow. While this condition was previously not common and more often found in elderly patients with heart valve disease, it’s emerging among young people who use opioids like heroin and fentanyl intravenously. This illness carries a high mortality rate, and survivors are left with life-long cardiac disease.

Vasodilation is a condition that causes the dilation of blood vessels caused by opioid use, which can lead to hypotension (low blood pressure), causing people to feel faint when standing up quickly. It can also cause orthostatic hypotension leading to severe lightheadedness when upright or syncope or frequent fainting.

The medical providers at Middlesex Recovery’s outpatient, office-based facilities are caring Providers who treat every patient as a whole. Along with the help of substance use counselors, Middlesex Recovery is dedicated to giving all patients the best quality of care. Give us a call today to learn more about our treatment programs.


  • ELECTROPHYSIOLOGY AND ARRHYTHMIAS, SESSION TITLE: ATRIAL FIBRILLATION. Abstract 12773: Association of Opioid Use With Atrial Fibrillation in a Post-9/11 Veteran Population. Jonathan D Stock, Philip Chui, Lindsey Rosman, Brian J Malm, Lori Bastian, and Matthew M Burg. Originally published5 Nov 2018Circulation. 2018;138:A12773

  • Pain Med. 2015 Oct;16 Suppl 1:S27-31. doi: 10.1111/pme.12915. Cardiac Effects of Opioid Therapy. Alexander Chen, Michael A Ashburn.

  • Associated Out-of-Hospital Cardiac Arrest: Distinctive Clinical Features and Implications for Health Care and Public Responses: A Scientific Statement From the American Heart Association. Published 8 Mar 2021 2021;143:e836–e870

  • Combining opioids and benzodiazepines: effects on mortality and severe adverse respiratory events. Martijn Boon1, Eveline van Dorp1, Suzanne Broens2, Frank Overdyk3

  • Department of Anesthesiology, Leiden university medical Center, Leiden, The Netherlands;2Department of Anesthesiology, Netherlands cancer institute, Amsterdam, The Netherlands;3Department of Anesthesiology, Trident Health System, Charleston, SC, USA

  • Acute endocarditis in intravenous drug users: a case report and literature review.Yan Ji, MD, PhD,1 Lara Kujtan, MD,2 and Dawn Kershner, DO3,*

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