The unique histology of methamphetamine cardiomyopathy: a case report.

This report describes the histological changes observed in the heart a young methamphetamine abuser who died of heart failure. Most of the microscopic changes in the heart have previously been described in experimental animals, but never clearly illustrated in man. Gross examination of the heart revealed concentric myocardial hypertrophy (heart weight 470 g versus median predicted weight of 312 g). Areas of old myocardial infarction were also evident, along with enzymatic evidence indicating that a new infarct had occurred. Myocardial remodeling was extensive with perivascular and interstitial fibrosis, cellular vacuolization, and ongoing myocyte destruction with proliferation of fibromyocytes in the intestitum. Of note were the widespread, bizarre looking, distorted, cell nuclei. They were reminiscent of those seen in viral-induced dilated congestive cardiomyopathy. Clinical chemical measurements also showed unequivocal evidence of both evolving infarction and profound heart failure, with a BNP > 5000. This pattern has not previously been reported in humans, probably because forensic pathologists rarely examine the hearts of methamphetamine abusers microscopically. If the pattern observed here is typical for methamphetamine-induced cardiotoxicity, it could well explain increasing reports of heart failure in methamphetamine abusers. It might also be diagnostic for the disorder.