Cardiovascular effects of cocaine: an autopsy study of 40 patients.
From September 1983 through November 1986, autopsies were performed on 6810 patients at the Office of the Maryland Medical Examiners; of these 40 had detectable cocaine, its metabolites, or both in body fluids. These patients were divided into two groups: natural cocaine-associated deaths (31 patients, mean age 28 +/- 5 years, blood level of cocaine 5.3 +/- 8.1 mg/L) and homicide deaths with detectable cocaine (nine patients, mean age 33 +/- 8 years, blood level of cocaine 0.3 +/- 0.3 mg/L). Cocaine-associated deaths were compared to a control group of 27 victims of sudden traumatic death (mean age 34 +/- 5 years). Total thrombotic occlusion of the left anterior descending coronary artery overlying mild coronary atherosclerosis occurred in one patient with cocaine-associated death. Results of histologic examination showed myocarditis (mononuclear infiltrate) in 8 of 40 (20%) patients dying with detectable cocaine in body fluids compared to 1 of 27 victims of sudden traumatic death (3.7%, p less than or equal to 0.05). Contraction band necrosis occurred in 25% of cocaine-associated deaths compared to a 41% incidence among victims of sudden traumatic death. We conclude that myocarditis occurs frequently in patients dying of cocaine abuse and may represent microvascular injury.
Virmani
R
R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, DC 20306-6000.
Robinowitz
M
M
Smialek
J E
JE
Smyth
D F
DF
D000328:Adult; D001344:Autopsy; D003042:Cocaine / Q000506:poisoning* / Q000633:toxicity; D005260:Female; D006321:Heart / Q000187:drug effects*; D006708:Homicide; D006801:Humans; D008297:Male; D008396:Maryland; D008875:Middle Aged; D009205:Myocarditis / Q000139:chemically induced* / Q000473:pathology; D009206:Myocardium / Q000473:pathology*; D009336:Necrosis; D019966:Substance-Related Disorders / Q000473:pathology*
D003042:Cocaine