Histological Findings of the Atrioventricular Conductive System in Street Heroin Addicts, Victims of Sudden Unexpected Death

Abstract

A study of the atrioventricular (AV) conducting tissue was considered necessary for the examination of probable histologic changes that could justify the arrhythmias observed in street-heroin addicts. Postmortem coronary angiography and microscopic examination were performed in 50 heroin addicts (group A) and in 50 nonaddicts (group B), all male 16-40 years old. In group A, fatty and/or fibrous tissue replaced the AV node in 50% of cases while in group B in 14%. The main bundle was replaced by fatty and/or fibrous tissue in 44% in group A cases and 10% in group B. Intimal proliferation and fibromuscular dysplasia of the AV arteries in group A were correspondingly 26% and 14% and in group B 6% and 2%. Inflammation with focal and/or diffuse concentration of round cells of the AV node was detected in 54% in group A. These findings could explain a possible arrhythmia mechanism in this population.

Heroin Abuse Results in Shifted RNA Expression to Neurodegenerative Diseases and Attenuation of TNFα Signaling Pathway

“…However, repeated administration of heroin results in the induction of dependence on heroin. The heroin-dependent patients (HDPs) are often associated with increased incidence of infectious diseases, as well as co-occurring medical conditions, including malnutrition, constipation, syphilis, HIV, Hepatitis C Virus (HCV), cardiovascular diseases, stroke, and mental disorders (such as depression) 3 – 5 . It has been reported that heroin is able to influence a variety of immune functions, which can directly act on immune cells through opioid receptors, and result in decreased in vitro T cell proliferation and cytokine production, and decreased phagocytosis and chemotaxis of macrophages.…”

Efeitos da Heroína nos Parâmetros Eletrocardiográficos

“…Os autores concluíram que essa pode ser a causa da arritmia relacionada à morte súbita em indivíduos dependentes de heroína. 9 , 10 Portanto, revelar alterações no ECG dependentes de heroína tornou-se ainda mais importante.…”

“…Furthermore, in studies investigating the mechanisms of heroin-related arrhythmias and subsequent sudden deaths, heroin use did not only lead to myocardial infiltration, but it also led to fibromuscular dysplasia in the sinus node, atrioventricular node and transmission pathways, and to fat infiltration; they concluded that this may be the cause of arrhythmia related to sudden death in heroin-dependent individuals. 9 , 10 Therefore, revealing heroin-dependent ECG changes has become even more important.…”

“…Além disso, há alguns estudos na literatura que mostram a relação entre heroína, toxicidade miocárdica e arritmias. 9 , 10 Portanto, é essencial compreender as alterações no ECG dependentes de heroína. O objetivo do presente estudo é investigar os efeitos da dependência de heroína sobre os parâmetros eletrocardiográficos.…”

“…There are also some studies in the literature showing the relation between heroin, myocardial toxicity, and arrhythmias. 9 , 10 Therefore, understanding heroin dependent ECG changes is essential. The aim of the present study is to investigate effects of heroin addiction on electrocardiographic parameters.…”