Abstract
Cocaine-related deaths occur regularly in forensic routine work. In cases in which the detected concentration of cocaine is rather low and other causes of death apart from intoxication can be ruled out, the question arises if adulterants of cocaine might have played a crucial role. In the present study, cardiac effects of cocaine, of the adulterant levamisole and of mixtures of both were evaluated using the isolated perfused Langendorff heart. While exposed to the substances, functional parameters heart rate, left ventricular pressure and coronary flow were documented. Relevant alterations of these parameters were found for cocaine as well as for levamisole. Exposing the hearts to a mixture of both resulted in a combination of these effects; the emergence of new alterations or an obvious aggravation were not detected. Nevertheless, the results imply that the consumption of cocaine adulterated with levamisole bares an increased risk for cardiac complications, especially in the presence of preexisting cardiac pathologies.
Highlights
Cocaine is one of the most frequently consumed drugs, and the number of consumers is still rising
We worked with an animal model, the isolated perfused Langendorff heart, in order to find out if levamisole might cause cardiac adverse effects that may play a role in sudden death after the consumption of street cocaine
Electric activity and heart rate were measured by placing one electrode at the apex, one electrode left to the left coronary artery (LCR) near the left atrial appendage and one electrode at the aorta
Summary
Cocaine is one of the most frequently consumed drugs, and the number of consumers is still rising. In 2016, the UNODC, the United Nation Office on Drugs and Crime, described an increase of the coca cultivation area of 52% to 146,000 ha with an estimated increase of cocaine production of 34% to 866 t per year [1]. In 2016, Germany faced more than 13.000 crimes related to cocaine which means a plus of 20.7% [2]. Approximately 1300 cases of death in Germany were related to the consumption of drugs. This number has risen for the fourth time in succession [3]. Five percent of drug fatalities were caused by cocaine or a combination of cocaine and other drugs [4]
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