This is a histological report of a myocardial lesion of a 44-year-old white man who was found dead
in a hotel with circumstances strongly suggestive of heroin intoxication. Based on autopsy findings and
toxicologic analysis, the present case was an instance of straightforward heroin overdose in snorter. The most
striking pathologic finding of the heart was a few patches of marked dark mottling appearance in the left
ventricle and ventricular septum. Histological appearance of the lesions revealed marked congestion with
intramyocardial extravasation of blood. Since the deceased had patent coronary arteries without evidence of
atheroma, the lesions were thought to be the results of coronary artery spasm. There has also been substantial
evidence in the previous reports to believe that the condition is secondary to heroin-induced coronary artery
spasm. However, its actual underlying mechanism remains unclear.

Keywords: Heroin intoxication, Myocardial lesion, Sudden death