Virmani R
Armed Forces Institute of Pathology, Washington, DC 20306-6000.
NIDA Res Monogr. 1991;108:220-9.
With regard to cardiac findings in cocaine abuse, at autopsy the vast majority of patients dying with cocaine toxicity have either no pathologic change in the heart or only minimal changes that could not account for the patient's death. The second most frequent finding is underlying, mild-to-moderate coronary atherosclerosis, with or without coronary thrombosis. There may be acute or healed myocardial infarction or a sudden cardiac death without myocardial changes of ischemia. A high incidence of contraction band necrosis has been reported in the absence of coronary artery disease and may cause a sudden arrhythmic death. Myocarditis also has been described in a few cases as either lymphocytic or lymphocytic and eosinophilic infiltrate in the presence of myocyte necrosis. Usually, the foci are sparse and not always associated with contraction band necrosis. The underlying mechanisms are thought to be either direct effects of norepinephrine on myocytes or through vasospasm of resistance vessels and secondary myocardial ischemia. Cocaine rarely has been associated with aortic dissection, which is probably a result of cocaine's hypertensive effects.
关于可卡因滥用的心脏表现，尸检时，绝大多数死于可卡因中毒的患者心脏要么没有病理变化，要么只有轻微变化，这些变化不足以解释患者的死亡。第二常见的发现是潜在的轻度至中度冠状动脉粥样硬化，伴或不伴有冠状动脉血栓形成。可能存在急性或愈合的心肌梗死，或无心肌缺血改变的心脏性猝死。在无冠状动脉疾病的情况下，已有关于收缩带坏死高发生率的报道，其可能导致心律失常性猝死。少数病例中也有心肌炎的描述，表现为淋巴细胞性或淋巴细胞和嗜酸性粒细胞浸润伴心肌细胞坏死。通常，病灶稀疏，并不总是与收缩带坏死相关。其潜在机制被认为是去甲肾上腺素对心肌细胞的直接作用，或通过阻力血管痉挛及继发性心肌缺血。可卡因很少与主动脉夹层相关，这可能是可卡因的高血压作用所致。
