Fatal coronary artery intimal hyperplasia due to amphetamine use

Amphetamines have been reported to cause myocardial infarct, cerebral hemorrhage, aortic dissection, hypertension, vasculitis, aneurysms, and, occasionally, death from direct toxicity. To date, there have been no reports of coronary intimal hyperplasia in an amphetamine user.

A 29-year-old male was found collapsed after jogging. He had been taking amphetamines for 11 years for attention deficit/hyperactivity disorder. Past medical history was positive for mild hypertension and migraine headaches. He underwent a complete autopsy and drug screen.

At gross autopsy his left anterior descending (LAD) coronary artery was occluded and he had an old myocardial infarct in the anterior wall of the left ventricle. Microscopic findings included occlusive intimal hyperplasia (positive for smooth muscle actin) in the LAD and an old left ventricular anterior wall infarct surrounded by acute infarct.

In addition to other reported adverse effects, amphetamines can also cause occlusive intimal hyperplasia of the coronary arteries.