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Geriatrics62 papers

Drug-related myocardial necrosis syndrome

Last edited: 4/14/2026

Overview

Drug-related myocardial necrosis syndrome refers to myocardial damage caused by adverse drug reactions, often seen in patients with polypharmacy and complex medical regimens. It highlights the critical need for vigilant monitoring and management of medication interactions to prevent serious cardiac complications 57.

Diagnosis

  • Clinical Presentation: Elevated cardiac biomarkers, electrocardiogram (ECG) changes indicative of myocardial injury 28.
  • Recommended Tests: Troponin levels, CK-MB, ECG, and echocardiography to assess myocardial function 28.
  • Evaluation of Drug Regimen: Comprehensive review of current medications for potential drug interactions and adverse effects 15.

    • Management

  • Medication Review: Conduct thorough review and potential adjustment of medications to eliminate causative agents 15.
  • Supportive Care: Management of heart failure symptoms, arrhythmias, and other complications as they arise 28.
  • Patient Education: Enhance patient understanding of medication adherence and potential side effects 8.
  • Pharmacovigilance: Utilize networks and systems for early detection and reporting of adverse drug reactions 11.

    • Special Populations

  • Elderly: Higher risk due to polypharmacy and age-related changes in pharmacokinetics and pharmacodynamics 728.
  • Comorbidities: Patients with pre-existing cardiovascular disease are particularly vulnerable 28.

    • Key Recommendations

  • Implement Medication Reconciliation: Regularly reconcile medications to identify and resolve drug-related problems, especially post-discharge 1215 (Evidence: Strong).
  • Enhance Clinical Pharmacist Involvement: Engage clinical pharmacists in medication reviews and patient education to prevent and manage DRPs 318 (Evidence: Strong).
  • Utilize Pharmacovigilance Networks: Leverage general practitioner pharmacovigilance networks for timely reporting and management of adverse drug reactions 11 (Evidence: Moderate).
  • Monitor Polypharmacy Closely: Closely monitor patients on multiple medications for signs of adverse drug reactions and myocardial necrosis 25 (Evidence: Moderate).
  • Promote Transitional Care Interventions: Implement nurse-led or multidisciplinary interventions during care transitions to minimize DRPs 321 (Evidence: Moderate).

    • References

    1 Aarabi SS, Semnani F, Aminzade Z, Mehrizi R, Gholamnezhad M, Armand R et al.. Prevalence, predictors, and clinical relevance of drug-drug interactions in outpatient prescribing: A national cross-sectional study. PloS one 2026. link 2 Kim S, Kim S, Kim C, Chang J, Park RW, Kim KW et al.. Impact of Regulatory Post-Market Safety Advisories on Prescribing Practices: An Interrupted Time Series Analysis. Clinical pharmacology and therapeutics 2025. link 3 Han Y, Chen J, Xu Y, Huang P, Hou L. Nurse-led medication management as a critical component of transitional care for preventing drug-related problems. Aging clinical and experimental research 2024. link 4 Hendrix MRS, Yasar M, Mohammad AK, Hugtenburg JG, Vanhommerig JW, Gündoğan-Yilmaz R et al.. Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide. BMC medical research methodology 2024. link 5 Dow P, Michaud V, Turgeon J. Multidrug Interactions: Why Do They Occur and How to Handle?. Clinical therapeutics 2023. link 6 Maslub MG, Radwan MA, Mikhail MS, Abdalla ZA, Youssef YL, Abdal Hafiz AI et al.. Assessment of the latest prescribed drug-related problems. European review for medical and pharmacological sciences 2022. link 7 Laroche ML, Van Ngo TH, Sirois C, Daveluy A, Guillaumin M, Valnet-Rabier MB et al.. Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. European geriatric medicine 2021. link 8 Huiskes VJB, Cramer-van der Welle CM, van den Ende CHM, van Dijk L, Bos JM, Kramers C et al.. Communication about Drug-Related Problems (DRPs) during Patients' Visits to Dutch Physicians and Pharmacies. Health communication 2020. link 9 Valeanu A, Damian C, Marineci CD, Negres S. The development of a scoring and ranking strategy for a patient-tailored adverse drug reaction prediction in polypharmacy. Scientific reports 2020. link 10 Glerum PJ, Maliepaard M, de Valk V, Scholl JHG, van Hunsel FPAM, van Puijenbroek EP et al.. Quantification of Adverse Drug Reactions Related to Drug Switches in The Netherlands. Clinical and translational science 2020. link 11 Jacquot J, Rousseau V, de Canecaude C, Montastruc JL, Durrieu G. Interest of a general practitioner pharmacovigilance network to provide drug information: A comparative study in France. Therapie 2020. link 12 Schepel L, Lehtonen L, Airaksinen M, Ojala R, Ahonen J, Lapatto-Reiniluoto O. Medication reconciliation and review for older emergency patients requires improvement in Finland. The International journal of risk & safety in medicine 2019. link 13 Meyer-Massetti C, Meier CR, Guglielmo BJ. The scope of drug-related problems in the home care setting. International journal of clinical pharmacy 2018. link 14 El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA, Karapinar-Çarkit F. Prevalence and Preventability of Drug-Related Hospital Readmissions: A Systematic Review. Journal of the American Geriatrics Society 2018. link 15 Basger BJ, Moles RJ, Chen TF. Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial. International journal of clinical pharmacy 2015. link 16 Basger BJ, Moles RJ, Chen TF. Application of drug-related problem (DRP) classification systems: a review of the literature. European journal of clinical pharmacology 2014. link 17 Kjeldsen LJ, Birkholm T, Fischer H, Graabæk T, Hansen MK, Kibsdal KP et al.. A national drug related problems database: evaluation of use in practice, reliability and reproducibility. International journal of clinical pharmacy 2014. link 18 Kjeldsen LJ, Birkholm T, Fischer H, Graabæk T, Kibsdal KP, Ravn-Nielsen LV et al.. Characterization of drug-related problems identified by clinical pharmacy staff at Danish hospitals. International journal of clinical pharmacy 2014. link 19 Hohmann C, Eickhoff C, Klotz JM, Schulz M, Radziwill R. Development of a classification system for drug-related problems in the hospital setting (APS-Doc) and assessment of the inter-rater reliability. Journal of clinical pharmacy and therapeutics 2012. link 20 Hanlon JT, Schmader KE. What types of inappropriate prescribing predict adverse drug reactions in older adults?. The Annals of pharmacotherapy 2010. link 21 Halvorsen KH, Ruths S, Granas AG, Viktil KK. Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. Scandinavian journal of primary health care 2010. link 22 Björkman IK, Sanner MA, Bernsten CB. Comparing 4 classification systems for drug-related problems: processes and functions. Research in social & administrative pharmacy : RSAP 2008. link 23 Lampert ML, Kraehenbuehl S, Hug BL. Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. Pharmacy world & science : PWS 2008. link 24 Krähenbühl JM, Kremer B, Guignard B, Bugnon O. Practical evaluation of the drug-related problem management process in Swiss community pharmacies. Pharmacy world & science : PWS 2008. link 25 Viktil KK, Blix HS, Moger TA, Reikvam A. Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. British journal of clinical pharmacology 2007. link 26 Etminan M, Gill S, Fitzgerald M, Samii A. Challenges and opportunities for pharmacoepidemiology in drug-therapy decision making. Journal of clinical pharmacology 2006. link 27 Triller DM, Clause SL, Hamilton RA. Risk of adverse drug events by patient destination after hospital discharge. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists 2005. link 28 Malhotra S, Karan RS, Pandhi P, Jain S. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgraduate medical journal 2001. link

    Original source

    1. [1]
      Prevalence, predictors, and clinical relevance of drug-drug interactions in outpatient prescribing: A national cross-sectional study. — Aarabi SS, Semnani F, Aminzade Z, Mehrizi R, Gholamnezhad M, Armand R et al. PloS one (2026)
    2. [2]
      Impact of Regulatory Post-Market Safety Advisories on Prescribing Practices: An Interrupted Time Series Analysis. — Kim S, Kim S, Kim C, Chang J, Park RW, Kim KW et al. Clinical pharmacology and therapeutics (2025)
    3. [3]
      Nurse-led medication management as a critical component of transitional care for preventing drug-related problems. — Han Y, Chen J, Xu Y, Huang P, Hou L Aging clinical and experimental research (2024)
    4. [4]
      Prescription Sequence Symmetry Analysis (PSSA) to assess prescribing cascades: a step-by-step guide. — Hendrix MRS, Yasar M, Mohammad AK, Hugtenburg JG, Vanhommerig JW, Gündoğan-Yilmaz R et al. BMC medical research methodology (2024)
    5. [5]
      Multidrug Interactions: Why Do They Occur and How to Handle? — Dow P, Michaud V, Turgeon J Clinical therapeutics (2023)
    6. [6]
      Assessment of the latest prescribed drug-related problems. — Maslub MG, Radwan MA, Mikhail MS, Abdalla ZA, Youssef YL, Abdal Hafiz AI et al. European review for medical and pharmacological sciences (2022)
    7. [7]
      Mapping of drug-related problems among older adults conciliating medical and pharmaceutical approaches. — Laroche ML, Van Ngo TH, Sirois C, Daveluy A, Guillaumin M, Valnet-Rabier MB et al. European geriatric medicine (2021)
    8. [8]
      Communication about Drug-Related Problems (DRPs) during Patients' Visits to Dutch Physicians and Pharmacies. — Huiskes VJB, Cramer-van der Welle CM, van den Ende CHM, van Dijk L, Bos JM, Kramers C et al. Health communication (2020)
    9. [9]
      The development of a scoring and ranking strategy for a patient-tailored adverse drug reaction prediction in polypharmacy. — Valeanu A, Damian C, Marineci CD, Negres S Scientific reports (2020)
    10. [10]
      Quantification of Adverse Drug Reactions Related to Drug Switches in The Netherlands. — Glerum PJ, Maliepaard M, de Valk V, Scholl JHG, van Hunsel FPAM, van Puijenbroek EP et al. Clinical and translational science (2020)
    11. [11]
      Interest of a general practitioner pharmacovigilance network to provide drug information: A comparative study in France. — Jacquot J, Rousseau V, de Canecaude C, Montastruc JL, Durrieu G Therapie (2020)
    12. [12]
      Medication reconciliation and review for older emergency patients requires improvement in Finland. — Schepel L, Lehtonen L, Airaksinen M, Ojala R, Ahonen J, Lapatto-Reiniluoto O The International journal of risk & safety in medicine (2019)
    13. [13]
      The scope of drug-related problems in the home care setting. — Meyer-Massetti C, Meier CR, Guglielmo BJ International journal of clinical pharmacy (2018)
    14. [14]
      Prevalence and Preventability of Drug-Related Hospital Readmissions: A Systematic Review. — El Morabet N, Uitvlugt EB, van den Bemt BJF, van den Bemt PMLA, Janssen MJA, Karapinar-Çarkit F Journal of the American Geriatrics Society (2018)
    15. [15]
      Impact of an enhanced pharmacy discharge service on prescribing appropriateness criteria: a randomised controlled trial. — Basger BJ, Moles RJ, Chen TF International journal of clinical pharmacy (2015)
    16. [16]
      Application of drug-related problem (DRP) classification systems: a review of the literature. — Basger BJ, Moles RJ, Chen TF European journal of clinical pharmacology (2014)
    17. [17]
      A national drug related problems database: evaluation of use in practice, reliability and reproducibility. — Kjeldsen LJ, Birkholm T, Fischer H, Graabæk T, Hansen MK, Kibsdal KP et al. International journal of clinical pharmacy (2014)
    18. [18]
      Characterization of drug-related problems identified by clinical pharmacy staff at Danish hospitals. — Kjeldsen LJ, Birkholm T, Fischer H, Graabæk T, Kibsdal KP, Ravn-Nielsen LV et al. International journal of clinical pharmacy (2014)
    19. [19]
      Development of a classification system for drug-related problems in the hospital setting (APS-Doc) and assessment of the inter-rater reliability. — Hohmann C, Eickhoff C, Klotz JM, Schulz M, Radziwill R Journal of clinical pharmacy and therapeutics (2012)
    20. [20]
      What types of inappropriate prescribing predict adverse drug reactions in older adults? — Hanlon JT, Schmader KE The Annals of pharmacotherapy (2010)
    21. [21]
      Multidisciplinary intervention to identify and resolve drug-related problems in Norwegian nursing homes. — Halvorsen KH, Ruths S, Granas AG, Viktil KK Scandinavian journal of primary health care (2010)
    22. [22]
      Comparing 4 classification systems for drug-related problems: processes and functions. — Björkman IK, Sanner MA, Bernsten CB Research in social & administrative pharmacy : RSAP (2008)
    23. [23]
      Drug-related problems: evaluation of a classification system in the daily practice of a Swiss University Hospital. — Lampert ML, Kraehenbuehl S, Hug BL Pharmacy world & science : PWS (2008)
    24. [24]
      Practical evaluation of the drug-related problem management process in Swiss community pharmacies. — Krähenbühl JM, Kremer B, Guignard B, Bugnon O Pharmacy world & science : PWS (2008)
    25. [25]
      Polypharmacy as commonly defined is an indicator of limited value in the assessment of drug-related problems. — Viktil KK, Blix HS, Moger TA, Reikvam A British journal of clinical pharmacology (2007)
    26. [26]
      Challenges and opportunities for pharmacoepidemiology in drug-therapy decision making. — Etminan M, Gill S, Fitzgerald M, Samii A Journal of clinical pharmacology (2006)
    27. [27]
      Risk of adverse drug events by patient destination after hospital discharge. — Triller DM, Clause SL, Hamilton RA American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists (2005)
    28. [28]
      Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. — Malhotra S, Karan RS, Pandhi P, Jain S Postgraduate medical journal (2001)
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