Top 3 Antibiotics That Increase Heart Attack Risk
Certain antibiotics used to treat pneumonia, bronchitis and bacterial infections may increase the risk of heart attack, but only for people with underlying heart disease such as arrhythmias, structural changes to the heart, or heart damage from a previous heart attack. Read on to find out which three antibiotics pose the highest risk.
Cardiovascular death linked to macrolides
Macrolides are the most commonly prescribed antibiotics, and are used to treat a number of bacterial infections. Under the umbrella of macrolides are the commonly prescribed antibiotics azithromycin, erythromycin and clarithromycin. Research published in the New England Journal of Medicine studied more than a million cases of antibiotic-treated patients in 2012, and discovered some scary findings.
The study found that patients taking azithromycin for five days were three times more likely to suffer a fatal cardiovascular event, compared with patients who took no antibiotics. Azithromycin, it seems, also caused irregular heartbeats in some patients. Similarly, erythromycin and clarithromycin were found to be linked to an increased risk of sudden cardiac death, according to the study.
Anotherstudy published in the Journal of the American College of Cardiology analyzed 33 studies involving more than 20 million patients between 1966 and 2015. Researchers compared patients treated with macrolides to similar patients treated with other antibiotics or patients who did not receive antibiotic therapy.
What Is Resting Heart Rate
Resting heart rate is your baseline heart rate. It is the number of beats per minute your heart makes when you are relaxed, sitting or lying down, and not doing physical activity.
To calculate your heart rate, first find your pulse by placing your index and middle finger either on your wrist under the base of your thumb, or on your neck on either side of your windpipe. You may need to move your fingers slightly until you feel the steady pumping.
Watching a clock with a minute reading, count the number of beats you feel in 15 seconds and multiply that by 4.
Resting heart rate = ____ beats per 15 seconds x 4.
More Research Urgently Needed Scientists Say
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One of the most commonly prescribed antibiotics has been linked with an increased risk of death from heart disease, researchers have said.
Clarithromycin, which is used in the treatment of many bacterial infections, is given to millions of people every year. Its use is already discouraged in patients with certain heart conditions, but in a new analysis of patient data carried out by Danish researchers, the drug was found to cause 37 potentially avoidable deaths compared to similar antibiotics for every one million courses of the antibiotic prescribed.
Although this level of risk is small, they said that the fact that clarithromycin is prescribed to so many people meant that urgent confirmation of their findings was required. However, they did not recommend any immediate changes to prescribing practice.
Clarithromycin belongs to a group of antibiotics known as macrolides. These antibiotics are known to affect the rhythm of the heart muscles electrical activity known as the QT interval and are therefore thought to increase the risk of potentially fatal heart rhythm problems.
Doctors already know to exercise caution when prescribing the drugs to patients with a rare condition called Long QT syndrome, which causes episodes of rapid heart rhythm, or arrhythmia.
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What Is Maximum Heart Rate
Your maximum heart rate is the rate at which your heart is beating when it is working its hardest.To estimate your maximum heart rate, start with 220 and subtract your age. For example, someone who is 30 would have an estimated age-related maximum heart rate of 190, while someone who is 70 would have an estimated age-related maximum heart rate of 150.
Maximum heart rate = 220 age.
Antibiotics And Cardiac Risk: A Look At Recent Data A Call For Increased Awareness
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In recent years, reports of increased risk for cardiac events associated with use of some antibiotics have been under the spotlight. Widely used antibiotics such as azithromycin have been linked to risk for mortality and others have been linked to pronounced effects on QT interval prolongation. Growing attention on the link led the FDA to issue public health advisories cautioning physicians and patients about usage of certain antibiotics in patients who are already at risk for CV events.
Experts Cardiology Today interviewed said recent reports should not cause undue alarm, but rather underscore the need for careful consideration of antibiotic regimens in patients with known CV risk. Increased awareness and education on which antibiotics can raise the risk for CV events and in which patients higher risk is most likely to occur are key, they said.
The prescribing of any antibiotic is a trade-off between the risks and the benefits. The adverse cardiac events are just like any other adverse effects, such as photosensitivity or superinfection with Clostridium difficile,Wayne A. Ray, PhD, professor of public health policy at Vanderbilt University School of Medicine, said in an interview. These effects need to be considered in the prescribing decision.
Image: Marty Perlman
Mechanisms of risk
Recent reports of interest
Wayne A. Ray
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Testing Azithromycin For Covid
Despite potential heart risks, some scientists are currently conducting clinical trials to see if giving azithromycin to patients recently diagnosed with COVID-19 might help prevent severe infections that require hospitalization.
Researchers at the University of California in San Francisco are recruiting 2,500 adults for a trial investigating azithromycin for this purpose. The study team said its possible that macrolides the family of antibiotics that includes azithromycin might help curb inflammation and viral replication in people with mild COVID-19 infections.
But the National Institute for Allergy and Infectious Diseases halted another trial testing azithromycin in combination with hydroxychloroquine shut down early because not enough people enrolled. In a statement announcing the end of this trial, scientists said a move by the FDA to revoke emergency approval for hydroxychloroquine for hospitalized COVID-19 patients may have curbed participation in the NIAID study.
And, an analysis of research to date on azithromycin and hydroxychloroquine for COVID-19published in May 2020 in Circulation concluded that both medicines may independently increase the risk of potentially fatal heart rhythm disorders in COVID-19 patients. Patients given both drugs together had an even higher risk of these heart issues, researchers reported.
Complications Of Sepsis And Septic Shock
The decreased blood pressure and small clots lead to a series of harmful complications:
Blood flow decreases to vital organs .
The heart attempts to compensate by working harder, increasing the heart rate and the amount of blood pumped. Eventually, the bacterial toxins and the increased work of pumping weaken the heart. As a result, the heart pumps less blood, and vital organs receive even less blood.
When tissues do not receive enough blood, they release excess lactic acid into the bloodstream, making the blood more acidic or by a buildup of carbon dioxide in the blood… read more ).
All of these effects result in a vicious circle of worsening organ malfunction:
The kidneys excrete little or no urine, and metabolic waste products accumulate in the blood.
The walls of blood vessels may leak, allowing fluid to escape from the bloodstream into tissues and cause swelling.
Lung function worsens because blood vessels in the lungs leak fluid, which accumulates, making breathing difficult.
As the microscopic blood clots continue to form, they use up the proteins in blood that make up clots . Then, excessive bleeding Disseminated intravascular coagulation is a condition in which small blood clots develop throughout the bloodstream, blocking small blood vessels. The increased clotting depletes the platelets… read more ) may occur.
Antibiotics And Abnormal Heartbeats
Antibiotics are overprescribed and overused. In fact, very few people can say they have never taken one. And this has led to the creation of superbugs like MRSA and CRE, as I told you last week.
But taking an antibioticeven when completely necessarymay pose another danger. According to a new FDA warning, one common antibiotic can cause serious heart arrhythmias. Even fatal arrhythmias.
Ill tell you which common antibiotic causes the problems in a moment. But first, let me back up a moment.
Last month, I explained a little bit about what FDA warnings mean. And what they dont mean. They often leave doctors scrambling to find answers. And what they should do to protect their patients.
I also told you about a new antidepressant drug called Celexa. The FDA issued a warning that Celexa could cause heartbeat abnormalities. But the FDA warning was so vague, doctors at Massachusetts General Hospital conducted their own research to uncover the truth. Eventually, the MGH doctors discovered that Celexa could cause a prolonged QT interval.
As youll recall, a QT interval is the time from the beginning of electrical activation of the heart to the end of electrical relaxation. Most people who get QT prolongation have no heart rhythm abnormalities. However, it is a recognized risk factor for a dangerousoften fatalheart arrhythmia called torsades de pointes.
The MGH doctors uncovered a strong link between Celexa and a prolonged QT interval.
Moderation is a good guide.
Symptoms Of Sepsis And Septic Shock
Most people have a fever, but some have a low body temperature. People may have shaking chills and feel weak. Other symptoms may also be present depending on the type and location of the initial infection . Breathing, heart rate, or both may be rapid.
As sepsis worsens, people become confused and less alert. The skin becomes warm and flushed. The pulse is rapid and pounding, and people breathe rapidly. People urinate less often and in smaller amounts, and blood pressure decreases. Later, body temperature often falls below normal, and breathing becomes very difficult. The skin may become cool and pale and mottled or blue because blood flow is reduced. Reduced blood flow may cause tissue, including tissue in vital organs , to die, resulting in gangrene Gas Gangrene Gas gangrene is a life-threatening infection of muscle tissue caused mainly by the anaerobic bacteria Clostridium perfringens and several other species of clostridia. Gas gangrene can develop… read more .
When septic shock develops, blood pressure is low despite treatment. Some people die.
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What Is Heart Rate Variability
While heart rate refers to the number of times your heart beats per minute, heart rate variability measures the time between each heartbeat. Also known as an R-R interval, this beat-to-beat interval variation is measured in milliseconds and can vary depending on a number of factors.
For instance, the interval between heartbeats is generally longer on your exhales and shorter when you inhale. So even if your heart rate is 60 beats per minute, the time between these beats is rarely one exact second. Within the same minute, you could have a 0.8-second interval between one set of heartbeats and then a 1.13-second interval between another set.
This probably seems overly scientific and perhaps not that useful for the everyday amateur athlete. However, being able to answer the question what is HRV? can in fact provide you with important information about your overall health and the progression of your current training plan.
There are a variety of factors that can influence or change your HRV metrics. These include:
- Age and gender
Another reason for this great variance in heart rate is because of our nervous system. Your parasympathetic nervous system receives input from your organs, which can cause a decrease in your heart rate. On the other hand, your sympathetic nervous system reacts to outside factors like exercise and stress and can increase your heart rate.
Fda Warns Some Antibiotics Can Cause Fatal Heart Damage
Certain antibiotics can cause painful and sometimes fatal damage to the bodys main artery, the Food and Drug Administration said Thursday.
Fluoroquinolone antibiotics might raise the risk of an aortic dissection, and people who are already at risk should be cautious about taking those antibiotics, the FDA said.
A U.S. Food and Drug Administration review found that fluoroquinolone antibiotics can increase the occurrence of rare but serious events of ruptures or tears in the main artery of the body, called the aorta. These tears, called aortic dissections, or ruptures of an aortic aneurysm can lead to dangerous bleeding or even death, the FDA said in a statement.
Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available. People at increased risk include those with a history of blockages or aneurysms of the aorta or other blood vessels, high blood pressure, certain genetic disorders that involve blood vessel changes, and the elderly.
The FDA said the new risk guidance will be added to the labels and prescribing information of fluoroquinolone drugs. The agency has already warned that the powerful drugs should only be used when absolutely necessary because they can cause other side effects involving tendons, muscles, joints, nerves and the central nervous system.
Fda Warns Antibiotic Zithromax Can Cause Irregular Heart Activity
The U.S. Food and Drug Administration has issued a warning stating that the commonly prescribed antibiotic azithromycin can cause irregular heart activity and result in a fatal heart rhythm. such as pneumonia, bronchitis, wheezing and COPDpotassiummagnesiumdoctors should be aware of the risk of fatal heart rhythm associated with azithromycin and consider prescribing alternative antibiotics among their patients with existing heart conditions or low blood-potassium/magnesium levelsWarnings and PrecautionsNew England Journal of Medicineantibiotic
The study reported an increase in cardiovascular deaths, and in the risk of death from any cause, in persons treated with a 5-day course of azithromycin compared to persons treated with amoxicillin, ciprofloxacin, or no drug. The risks of cardiovascular death associated with levofloxacin treatment were similar to those associated with azithromycin treatment.
- Acute bacterial exacerbations of chronic pulmonary disease
- Uncomplicated skin and skin structure infections
- Urethritis and cervicitis
Prognosis Of Sepsis And Septic Shock
Without treatment, most people with septic shock die. Even with treatment, there is a significant risk of death. On average, about 30 to 40% of people with septic shock die. However, the risk of death varies greatly depending on many factors, including how quickly people are treated, the type of bacteria involved and the person’s underlying health status.
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Healthfda Strengthens Warning On Powerful Antibiotics
Health care professionals should avoid prescribing fluoroquinolone antibiotics to patients who have an aortic aneurysm or are at risk for an aortic aneurysm, such as patients with peripheral atherosclerotic vascular diseases, hypertension, certain genetic conditions such as Marfan syndrome and Ehlers-Danlos syndrome, and elderly patients. Prescribe fluoroquinolones to these patients only when no other treatment options are available, the FDA said.
Patients should call 911 or get to an emergency room if they feel symptoms of an aortic dissection, which include sudden, severe, and constant pain in the stomach, chest or back, the FDA said.
People who have high blood pressure, who know they have an aneurysm a thinning of the artery walls or heart disease should tell their doctors before taking antibiotics.
High blood pressure is the main cause of aortic dissections, which involves the inner layer of the wall or the aorta tearing away from the middle wall.
Fluoroquinolones are very commonly used antibiotics. They include: ciprofloxacin, also known as Cipro levofloxacin, or Levaquin gemifloxacin, or Factive and moxifloxacin, or Avelox.
They are widely prescribed to treat upper respiratory infections and urinary tract infections.
Be aware that symptoms of an aortic aneurysm often do not show up until the aneurysm becomes large or bursts, so report any unusual side effects from taking fluoroquinolones to your health care professional immediately, the FDA said.
Mixed Results From Previous Studies
An earlier study published in The New England Journal of Medicine found taking azithromycin for five days was associated with a 2.9-fold greater risk of cardiovascular death than taking no antibiotics at all, as well as an 85 percent higher risk of death from all causes. Based in part on safety concerns raised by this study, the U.S. Food and Drug Administration warned against prescribing azithromycin to patients with known risk factors for ventricular arrhythmia, a type of abnormal heart rhythm.
Since then, several other studies have linked azithromycin to an increased risk of cardiovascular-related deaths, serious heart rhythm abnormalities, or heart attacks, Zaroff and colleagues point out in their own paper. For example, one study of older patients with pneumoniapublished in the Journal of the American Medical Association tied azithromycin to a 17 percent increased risk of heart attacks.
However, other studies have found the opposite that there wasnt any connection between azithromycin and cardiac deaths. For example, a study of Medicare beneficiaries published in April 2018 in the Journal of the American Heart Association found no link between macrolides, the family of antibiotics that includes azithromycin, and the risk of having or dying from cardiac events like heart attacks, strokes, or heart rhythm abnormalities.
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Limitations Of The Study
The study wasnt a controlled experiment designed to prove that azithromycin directly causes heart problems or fatalities.
One limitation of the study is that its possible that the severity of infections treated with antibiotics impacted both the decision about whether to use azithromycin and the risk of cardiac-related deaths, the study team notes.
Even so, the results add to a body of evidence suggesting that clinicians should avoid azithromycin for patients who are predisposed to certain kinds of heart rhythm problems, says Salim Virani, MD, PhD, a professor and director of the cardiology fellowship training program at Baylor College of Medicine in Houston, who wasnt involved in the current study.
Azithromycin can cause whats known as a prolonged QT interval, when the electrical system in the heart takes longer than it should to recharge between beats. This delay is visible on an EKG, and can lead to a potentially fatal abnormal heart rhythm, says Dr. Virani.
This risk is especially high in those with preexisting heart disease and as one would expect, Virani says.
Even though the overall risk of heart-related deaths with azithromycin is relatively low, heart disease is quite common, making it crucial that patients are aware of this potential side effect, Virani adds.