Right Atrial Perforation in the Setting of Methamphetamine-Associated Cardiomyopathy

Right atrial perforation is a rare sequela of a few clinical situations, such as acute myocardial infarction, invasive cardiac procedures, or cardiac malignancies. This case is a novel example of a right atrial perforation due to methamphetamine-associated cardiomyopathy. The decedent was a 44-year-old male with a history of methamphetamine use who suffered a witnessed collapse and was pronounced on scene. His autopsy showed findings consistent with acute and chronic sympathomimetic drug use, such as cardiomegaly with dilated cardiomyopathy, necrosis, perforation of the right atrium, and hepatitis. Toxicologic evaluation revealed methamphetamine and benzoylecgonine. Eight hundred milliliters of bloody fluid was removed from the pericardial space. On histologic examination, the right atrium demonstrated acute hemorrhage, mild to moderate patchy fibrosis with myocyte necrosis, and mixed acute and chronic inflammation. The cause of death was classified as cardiac tamponade secondary to a right atrial perforation. Searches of PubMed and Google Scholar failed to provide a report of this complication. This case provides an example of a rare and possibly novel cardiac pathology that occurred as a complication of methamphetamine-associated cardiomyopathy.