So I had what my doctors believe to be either a heart attack or stress-induced congestive heart failure about eight months ago; there was no blockage of the coronary artery, and they suspect either a random vasospasm or Takotsubo cardiomyopathy (
linked here). I have a mild arrhythmia with premature ventricular contractions (PVCs) every 5-15 beats or so, and I'm currently on 5mg lisinopril and 100mg metoprolol for continuing management of blood pressure and heart rate. At the time of the incident I was told it was probably wise to swear off any and all stimulant use, but I'm still in school for engineering and have trouble focusing enough to get a large quantity of work done. I've been occasionally using small quantities of caffeine to power through things, but it's not necessarily great at motivating me to get things done.
Are you sure you even had a heart attack? Sounds like a panic attack to me. I've never heard of stress causing a heart attack, unless you are at least middle aged or older, in which case the cortisol build-up from stress might cause it, especially if you have a genetic susceptibility to it. Are you obese by chance? How is your diet and exercise? Not to be offensive or anything, but blood pressure shouldn't be treated with medications unless it is a last resort. You can easily lower blood pressure just by walking everyday and since you have no artery blockages, sounds like your cholesterol is fine. But the fact the only symptoms they found were high blood pressure and a fast heart rate, lead me to believe you got some shit doctor who mis-diagonosed a panic attack for a heart attack (it happens all the time, most doctors really got their education from a dumpster).
Your heart doesn't just stop beating for no reason. As for arrhythmia, if it is only mild, that wouldn't cause a heart attack. As for the contractions, that leads me think you might have a simple case of heart failure, not a heart attack, which means that you can easily reverse it just by eating better, exercising, and relaxing more often (seriously, heart failure isn't as bad as it sounds).
An actual heart attack would be a shitload of pain like pain you have never experienced before, I'm talking getting kicked in the balls and banging your elbow on a wooden table repeatedly type of pain, it isn't something you can mistake, and if it happens to you, you won't be doing fuck all but clutching your chest and falling to the ground unable to even think at all. A panic attack on the other hand, you probably spent a bunch of time freaking out because of a chest pain and went to the ER and had some tests taken and freaked? Just wondering. If it was a heart attack, you wouldn't just drive yourself to the hospital, were you carted in by paramedics, or did you get there yourself? If the latter, I'd suggest a panic attack.
Did you get an actualy EKG done or just heart rate/blood pressure taken? I'd get bloodwork done and screen for coristol levels, lowering those will help A LOT. If you had an EKG it would confirm it better, I really don't think it was a heart attack.
Also, if you do have heart failure, realize heart failure doesn't mean your heart is failing, it means it isn't working as well as it should. A simple way to test this is go for a walk up some stairs and see how winded you get, or just go for a walk at all. If you get out of breathe really easily while exerting, but are fine just sitting around, then it is heart failure. However, a panic attack can still present itself in this way, but a panic attack doesn't go away when you sit down, heart failure will.
I'm interested in perhaps using small quantities of amphetamines or other CNS stimulants to help motivate me, but given the situation I'm concerned about cardiovascular effects (vasoconstriction, hypertension, tachycardia, increased risk of further damage to my heart). My questions are:
Vasoconstriction is a joke. Your arteries tighten up a bit? Unless you have really high cholesterol or some fucked up arteries, this isn't even worth worrying about for anyone.
Hypertension? Start exercising and this isn't a problem.
Tachycardia? Also not a problem. Your heart rate goes up like 20 points at maximum from stimulants alone, unless you take a shitload, again, like vasoconstriction, its a fancy word that means nothing.
As for damage to the heart... this takes DECADES to happen, if it happens at all. There's never been a scientifically-proven study showing stimulants cause significant damage to the heart, anymore than caffeine, fast food, using computers, or stress itself. It is all guesswork with shoddy evidence. Case-in-point? Numerous stimulants users that lived long lives without heart problems, in fact, I'm convinced heart problems are almost entirely genetic (aside from obvious shit like running marathons, clogged arteries, diseases, etc).
Still, not saying it doesn't damage your heart, just saying, if it does, there's no proof it will kill you in the immediate future.
1) Are there non-amphetamine CNS stimulants with a significantly less problematic cardiovascular side effect profile that I'd be able to use for performance and motivation?
They really shouldn't be a problem unless you have a seriously damaged heart. Get an EKG and bloodwork done, maybe an ex-ray first, if there's no serious abnormalities (mild arrhythmia isn't a serious condition), you have the green light to go ahead... but... huge disclaimer here; I'm not saying go do it and there's no risk, I'm saying, it isn't like putting a loaded gun in your mouth risk, more of a, skiing or racing fast cars risk, depending on the severity. Now if it is a severe problem, I suggest not using them at all, but learning motivation through other means.
2) Are there medications that it would be reasonable to co-administer with CNS stimulants (alpha blockers, additional doses of ACE inhibitors and beta blockers) to control cardiovascular side effects?
I wouldn't recommend it because there might be a complication that can arise that isn't understood by modern science. It is sort of like using rubber gloves to pickup snakes, it might help somewhat, but you are still playing with fire if it is a problem.
3) How likely am I to do permanent damage and/or land myself in the ER if I were to take a single dose of 0.1mg/kg racemic amphetamine sulfate without additional cardioprotective measures?
As for permanent damage? Probably extremely unlikely. Landing in the ER? I also doubt it severely, but I cannot access you based on the information provided.
A mild arrhythmia occurs even in chronic stimulants users, which is probably a non-issue if that is the case.
As for ventricular contractions, that leads me to wonder what exact problem you have, it could be as benign as the former points; something every chronic stimulant user themself has, a side-effect from something you are taking, or indications of a worsening condition.
You really need an EKG and bloodwork done and to list other medications you are on to really help you. As for the blood pressure medication, I'd suggest getting away from that and exercising instead. Using medications to manage blood pressure should be a last resort.
Good luck at any rate, if you can go get some additional tests done, I could help you better.
