The medical blogosphere’s response to the death of Anna Nicole Smith is beginning to read like a virtual CPC. So far myocarditis, serotonin syndrome, cardiomyopathy, congenital heart disease, heritable disorders of connective tissue, pulmonary embolism, WPW, ischemic heart disease, Brugada syndrome and drug overdose and/or interaction have been posited.
Methadone garnered more attention in the last few days following reports that it was found in her refrigerator. As I posted here methadone could have caused an arrhythmic death. It causes prolongation of the QT interval and torsade de pointes, effects which would not be mitigated by narcotic tolerance or the use of Narcan. These electrophysiologic effects are under appreciated and may be responsible for many of the deaths recently reported in association with abuse of methadone.