Steven b Karch md Assistant Medical Examiner City and County of San Francisco California

The frequency of heart disease in drug abusers is not known with any certainty, and is difficult even to estimate. The observed frequency of any particular cardiac lesion depends on the pattern of drug abuse within the population being studied. Before the HIV era, in areas where heroin was the favored drug, the incidence of heart disease in drug users appeared to be not significantly different from that seen in controls.1 In Siegel and Helpern's classic paper on the "Diagnosis of Death from Intravenous Narcotism", heart disease was not even mentioned,2 nor were any significant cardiac abnormalities noted in Wetli's study of 100 consecutively autopsied narcotic abusers.3 Thirty years ago, when Louria analyzed the discharge diagnosis of addicts admitted to Bellevue Hospital's general medicine service, the incidence of endocarditis was under 10% and no other cardiac disorders were noted.4 By contrast, pathologists in Scandinavia, where amphetamine abuse is common, often report finding contraction band necrosis, fibrosis, and inflammatory infiltrates.5

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