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

• Published in: Journal of forensic sciences 2013-01, Vol.58 (s1), p.S99-S104
• Main Authors: Nerantzis, Christos E., Couvaris, Constantinos M., Pastromas, Socrates C., Marianou, Soultana K., Boghiokas, Ilias D., Koutsaftis, Philippos N.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; atrioventricular conductive tissue; Atrioventricular Node - pathology; Bundle of His - pathology; Cardiac arrhythmia; Case-Control Studies; Contrast Media; Coronary Circulation; Coronary Vessels - pathology; Death & dying; Death, Sudden - pathology; Drug addiction; Fibromuscular Dysplasia - pathology; Fibrosis - pathology; Forensic Pathology; forensic science; Forensic sciences; heart; Heroin; heroin addicts; Heroin Dependence - pathology; Histology; Humans; Inflammation - pathology; Male; Myocardium - pathology; Purkinje Cells - pathology; sudden death; Tissues; Tunica Intima - pathology; Young Adult
• ISSN: 0022-1198; 1556-4029
• DOI: 10.1111/j.1556-4029.2012.02304.x

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.