Pathological cardiac changes associated with recreational drug-related sudden cardiac death: a systematic review
- 1Department of Forensic Medicine and Clinical Toxicology, Zagazig University
- 2Department of Forensic Pathology, Egyptian Forensic Medicine Authority
Abstract
Background Recreational drug use has been associated with sudden cardiac death (SCD), but the pathological cardiac findings reported at autopsy vary among different substances. This systematic review aims to highlight the pathological findings of the most common recreational drugs associated with SCD. We conducted the initial literature search from March to April 2025. We conducted an updated search in September 2026 in PubMed, Web of Science, and Scopus to identify newly published eligible studies. Eligible studies included case reports, case series, and retrospective case series published in English that reported relevant pathological cardiac findings in recreational drug-related SCD. Studies without relevant autopsy findings or without a cardiac cause of death were excluded. Results Eighteen studies met the eligibility criteria, involving alcohol, cocaine, methamphetamine, novel opioids, nicotine, cannabis, and anabolic steroids. Cardiac enlargement was the most frequently reported pathological finding, followed by myocardial fibrosis. Myocardial infarction (MI) appeared in chronic cocaine and amphetamine users, with more prolonged effects in amphetamine users. Coronary artery disease was documented among cocaine and marijuana users, which can be differentiated by history and associated findings. At the same time, dilated cardiomyopathy was identified in studies involving alcohol, methamphetamine, and novel opioids. Conclusion In cases of recreational drug-related SCD, a complete forensic examination using police records, medical reports, histological examination, and toxicological analysis is important to reach the diagnosis. The reviewed evidence indicates that cardiac pathology may provide important supportive findings for postmortem interpretation.
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BibTeX
@article{abdelaal2026pathological,
title = {{Pathological cardiac changes associated with recreational drug-related sudden cardiac death: a systematic review}},
author = {Ghadeer M. M. Abdelaal and Hanan Hosny Hassan and Dena Mohamed Naguib Abdel Moawed},
journal = {Egyptian Journal of Forensic Sciences},
year = {2026},
month = oct,
doi = {10.1186/s41935-026-00588-9},
url = {https://doi.org/10.1186/s41935-026-00588-9},
note = {CC BY},
}
RIS
TY - JOUR
TI - Pathological cardiac changes associated with recreational drug-related sudden cardiac death: a systematic review
AU - Ghadeer M. M. Abdelaal
AU - Hanan Hosny Hassan
AU - Dena Mohamed Naguib Abdel Moawed
PY - 2026
DA - 2026/10/25
JO - Egyptian Journal of Forensic Sciences
DO - 10.1186/s41935-026-00588-9
UR - https://doi.org/10.1186/s41935-026-00588-9
AB - Background Recreational drug use has been associated with sudden cardiac death (SCD), but the pathological cardiac findings reported at autopsy vary among different substances. This systematic review aims to highlight the pathological findings of the most common recreational drugs associated with SCD. We conducted the initial literature search from March to April 2025. We conducted an updated search in September 2026 in PubMed, Web of Science, and Scopus to identify newly published eligible studies. Eligible studies included case reports, case series, and retrospective case series published in English that reported relevant pathological cardiac findings in recreational drug-related SCD. Studies without relevant autopsy findings or without a cardiac cause of death were excluded. Results Eighteen studies met the eligibility criteria, involving alcohol, cocaine, methamphetamine, novel opioids, nicotine, cannabis, and anabolic steroids. Cardiac enlargement was the most frequently reported pathological finding, followed by myocardial fibrosis. Myocardial infarction (MI) appeared in chronic cocaine and amphetamine users, with more prolonged effects in amphetamine users. Coronary artery disease was documented among cocaine and marijuana users, which can be differentiated by history and associated findings. At the same time, dilated cardiomyopathy was identified in studies involving alcohol, methamphetamine, and novel opioids. Conclusion In cases of recreational drug-related SCD, a complete forensic examination using police records, medical reports, histological examination, and toxicological analysis is important to reach the diagnosis. The reviewed evidence indicates that cardiac pathology may provide important supportive findings for postmortem interpretation.
SN - 2090-5939
SN - 2090-536X
ER -