[Myocardial involvement in nontraumatic rhabdomyolysis following an opiate overdose]

Eight young addicts developed rhabdomyolysis as a complication of heroin overdose. ECG, plasma enzyme time activity curves and thallium myocardial scintigraphy were highly suggestive of a myocardial lesion associated with rhabdomyolysis. Such changes were particularly striking in 3 patients with acute left ventricular failure, as shown by a hemodynamic investigation (3 patients) and by echocardiography (1 patient). All patients recovered but myocardial scintigraphy and ECG remained abnormal for a period ranging from 8 months to 3 years following the acute episode. Although associated metabolic changes may play a role in myocardial dysfunction, the most likely mechanism appears to be a direct toxic effect of heroin on cardiac muscle.