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Histologic Findings of the Sinus Node and the Perinodal Area in Street Heroin Addicts, Victims of Sudden Unexpected Death
Author(s) -
Nerantzis Christos E.,
Koulouris Spyridon N.,
Marianou Soultana K.,
Pastromas Socrates C.,
Koutsaftis Philipos N.,
Agapitos Emmanuel B.
Publication year - 2011
Publication title -
journal of forensic sciences
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.715
H-Index - 96
eISSN - 1556-4029
pISSN - 0022-1198
DOI - 10.1111/j.1556-4029.2011.01717.x
Subject(s) - heroin , heroin dependence , medicine , medical emergency , sudden death , poison control , injury prevention , psychiatry , drug
Sudden unexpected death is frequent in street heroin addicts. We conducted a histologic study of the sinus node (SN) to offer some evidence about the possible arrhythmogenic cause of death. Postmortem coronary angiography and microscopic examination of the SN and the perinodal area were performed in 50 heroin addicts (group 1) and in 50 nonaddicts (group 2), all men (16–40 years old). In heroin addicts, fatty and/or fibrous tissue replaced SN tissue in 21 cases (42%). Perinodal infiltration was found in 15 cases (30%). Fibromuscular dysplasia in branches of the sinus node artery (SNA) was found in eight cases (16%). Inflammation with focal and/or diffuse concentration of round cells was detected in the SN in 22 cases (44%). Old mural thrombi were also found in 13 cases (26%). The histologic changes in the SN and perinodal area offer an explanation about the possible mechanism of arrhythmia and sudden death in this population.