Sudden Unexpected Death of a Methamphetamine Abuser with Cardiopulmonary Abnormalities

Abstract

A 51-year-old man suddenly collapsed while being arrested. He was an abuser of methamphetamine (MP) with a history of previous convictions. The blood MP concentration at autopsy was below the lethal level. The heart revealed hypertrophy and endocardial thickening of the bilateral ventricles. On microscopic examination, the typical findings of hypertrophic cardiomyopathy were not seen, however endocardial thickening with increasing elastic fibres was seen in all the ventricles and in the atria. In the conduction system, the AV node artery with luminal narrowing was longitudinally compressed by circumferential tissue. Severe interstitial fibrosis and small scar formation of the superiorventricular septum were also seen. In addition, diffuse hypertensive pulmonary arteriopathy was seen in the lung parenchyma. We surmise that the AV node artery had been chronically compressed by the circumferential architecture, due to a chronic increase in intracardiac pressure. We believe that the pathological lesions noted in both the cardiac conduction system and the lung in our case may be a complication of MP abuse, and that an MP abuser with such lesions could easily die suddenly upon experiencing emotional stress.

Cardiovascular Monitoring of Children and Adolescents With Heart Disease Receiving Medications for Attention Deficit/Hyperactivity Disorder

“…120 Myocardial hypertrophy, endocardial thickening, myocardial injury, and cardiomyopathy have been demonstrated in regular abusers of methamphetamine. 115,116,121 Other Medications Approved for ADHD Strattera (Atomoxetine) Short-term studies of atomoxetine found a small but statistically significant increase in mean systolic blood pressure in adults and a marginal increase in diastolic blood pressure in adults and children, which decreased on discontinuation. 122 No ECG changes, including QT prolongation, were noted for all ages.…”

The Cardiac Complications of Methamphetamines

“…In animal studies, administration of methamphetamine to rats causes hypertension, tachycardia and myocardial toxicity with cellular death, fibrosis and contraction band necrosis [9]. In human autopsy specimens, severe interstitial fibrosis and scar formation has been documented [10]. Physiological pathways implicated include catecholamine surges acutely during methamphetamine intoxication with contingent hypertensive crises, longer-term upregulation of the sympathetic axis, and myocardial toxicity with impaired cellular metabolism.…”

Effect of an Electronic Control Device Exposure on a Methamphetamine‐intoxicated Animal Model

“…14 While the target effects in abusers are euphoria, motivation, and extroversion, these drugs can have significant cardiovascular, cerebral, metabolic, and psychiatric effects and can predispose the abuser to sudden death. [14][15][16] According to the Drug Abuse Warning Network statistics for 2006, there were 107,575 emergency department visits for amphetamines, comprising 11% of the visits for illicit drug abuse (cocaine accounted for 57% of the visits). 17 An Australian autopsy review showed an increase in amphetamine-positive deaths from 27 cases in 2001 to 46 cases in 2005.…”