title: Interpretation of lesions of the cardiac conduction system in cocaine-related fatalities.
abstract: This study examines cases of chronic drug users who died suddenly after drug administration. Victims were young subjects, aged from 19 to 35 from Switzerland and known to the police as long-term drug users. The circumstances of death suggested the occurrence of a sudden, unexpected death. Some victims were undergoing methadone treatment. In each case, a forensic autopsy and toxicological analyses were performed at the Institute of Forensic Medicine in Lausanne in Switzerland between 2002 and 2004, including hair analysis as a means to establish chronic drug use in general, and cocaine use in particular. The conduction system was examined histologically and cases showing potentially lethal changes were chosen for this report. The most frequent lesions found were severe thickening of the atrioventricular node artery, intranodal and perinodal fibrosis, and microscopic foci of chronic inflammatory infiltration. The authors conclude that pathological lesions in the conduction tissue may play a role in the occurrence of death attributed to intoxication consecutive to cocaine ingestion.
authors.affiliation: Institut Universitaire de Médecine Légale, University Hospital Center and University of Lausanne, Bugnon 21, 1005 Lausanne, Switzerland. Katarzyna.Michaud@chuv.ch
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Michaud
authors.forename: Marc
authors.initials: M
authors.lastname: Augsburger
authors.forename: Frank
authors.initials: F
authors.lastname: Sporkert
authors.forename: Marc
authors.initials: M
authors.lastname: Bollmann
authors.forename: Thomas
authors.initials: T
authors.lastname: Krompecher
authors.forename: Patrice
authors.initials: P
authors.lastname: Mangin
mesh_terms: D000328:Adult; D001283:Atrioventricular Node / Q000473:pathology*; D002036:Bundle of His / Q000473:pathology*; D003042:Cocaine / Q000032:analysis; D019970:Cocaine-Related Disorders / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology; D018765:Dopamine Uptake Inhibitors / Q000032:analysis; D005355:Fibrosis; D049429:Forensic Pathology; D053593:Forensic Toxicology; D006197:Hair / Q000737:chemistry; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007249:Inflammation / Q000473:pathology; D008297:Male; D009206:Myocardium / Q000473:pathology; D009336:Necrosis; D015813:Substance Abuse Detection
chemical_list: D018765:Dopamine Uptake Inhibitors; D003042:Cocaine