Epicardial coronary artery intimal smooth muscle hyperplasia in a Cocaine user

Bhavsar, Tapan; Hayes, T C; Wurzel, John

doi:10.4330/wjc.v3.i10.337

Cited by 5 publications

(1 citation statement)

References 3 publications

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“…Accelerated atherosclerotic disease of the epicardial arteries, but only rarely frank arterial thrombosis, is very frequently seen in chronic stimulant abusers (8)(9)(10)(11). Stimulant abusers may suffer from one of two different types of coronary artery disease: 1) an extraordinarily rare form of intimal and fibromuscular dysplasia, resembling that seen in transplant patients, that has only been reported in three cocaine users (12)(13)(14) (none with excited delirium), and 2) the same variety of atheromatous disease that affects much of the world's population. The mechanisms underlying accelerated atherosclerotic disease in stimulant abusers are not entirely clear, however, experimental studies suggest that cocaine has a multitude of pro-atherogenic effects on the vascular endothelium.…”

Section: Vascular Changes and Mechanismsmentioning

confidence: 99%

Possible Strategies for the Diagnosis of Fatal Excited Delirium Syndrome

Karch

2012

Academic Forensic Pathology

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Excited Delirium Syndrome (ExDS) is a term traditionally used in forensic literature to describe the symptoms and signs seen in a subgroup of patients with delirium who die in an agitated state. Components of this syndrome are altered mental status, combativeness and/or aggressiveness, increased tolerance to significant pain, tachypnea, profuse sweating, severe agitation, elevated temperature, delirium, and noncompliance with law enforcement and medical personnel. The individual may display "superhuman" strength and wear clothing inappropriate for the environment. Patients with this presentation are almost guaranteed to cause difficulties for law enforcement officers and medical staff. This review is written in hopes of minimizing some of these difficulties by 1) increasing general awareness and specific knowledge about this condition, 2) explaining the neurochemical and neuroanatomical alterations that have been shown to cause those symptoms, and 3) by suggesting new lines of research that might identify easily measured biomarkers for the disease. If the disease mechanism can be deciphered, then it should be possible to devise effective strategies for treatment. It would also be of enormous value to the legal system. When defending a diagnosis before the court, physical evidence always trumps knowledge and experience. It would be far better to be able to present physical proof than to opine that the decedent's behavior was typical for the disease. In this aspect, ExDS is analogous to myocardial infarction: if a man dies suddenly, it is much easier to prove the cardiac origin of the event if an occlusive thrombus is found in a major coronary artery.

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