24 Sep 2013

УДК 340.6_615.015.6_615.099.091


Y. Ismailova, A. Altayeva

Kazakh National Medical University in the name of S. D. Asfendiyarov.

RGKP «Center of Forensic Medicine» Almaty branch, Ministry of Health of

Republic of Kazakhstan



Results of pathologic-morphological researches of a myocardium and coronary vessels of the persons who have died of acute poisoning with drugs against chronic narcotic intoxication are presented in the article.  Microscopic research of tissues of heart was conducted with application of passable light and polarizing microscopy, thus, the revealed pathologic-morphological changes of a myocardium and coronary vessels at drug addicts were caused by long toxic influence of narcotic substances and alcohol, and also a chronic hypoxia of tissues, owing to spasm of blood vessels.  Degree of expressiveness of all revealed morphological changes depended on duration of the use of narcotic substances and age of the dead.

Keywords: forensic medical examination, sharp poisoning with narcotic substances, chronic narcotic intoxication, pathologic morphology of a myocardium and coronary vessels.


Morphological diagnostics of fatal poisonings by morphine for pathologists is a very actual medico-social problem, in connection with annually progressing quantity of lethal outcomes from poisoning with narcotic substances of men at young age [1, 2, 3, 4]. In practical work of forensic scientists there are situations at which poisoning assumed on autopsy with narcotic substance isn’t confirmed at the subsequent chemical and toxicological research. Therefore the results of judicial and histological (pathologic-morphological) research revealing pathological changes of bodies, testifying to intoxication narcotic substances [5] have importance. At chronic narcotic intoxication all organs and systems, including cardiovascular system are damaged. Therefore pathologic-morphological changes in them have direct impact on possibility of tanatogenesis, and also allow to establish an immediate cause of death and duration of the use of drugs. The question of an expert assessment of pathologic-morphological changes of a myocardium at morphine intoxication taking into account the age of victims remains actual so far [6, 7].

The purpose of our research was studying of cardiovascular pathology at sharp fatal poisonings with drugs against chronic narcotic intoxication.

Material and research methods: objects of research were heart, blood and urine of 120 samples. They were taken from dead men at autopsy who died because of poisoning with narcotic substances, aged from 15 till 30 years with «a narcotic experience» on the average 4,7±0,3 years. The chemical and toxicological blood test and urine, a method of a thin layer chromatography, revealed presence of morphine in all studied samples; from them in 30% morphine is found in a combination with ethyl alcohol. For morphological research of a myocardium and coronary vessels used histological methods of coloring of micro samples: hematoxylin and eosin, van Gizon, Veygert and Rego. Microscopic research of histologic preparations were conducted in passable and polarized light.

The results and discussion of pathologic-morphological researches of a myocardium revealed morphological signs of fibrillation of ventricles of heart in 86±0,4% of cases, in the form of the centers of wavy deformation, a contractual degeneration, various degree of expressiveness, and fragmentation of muscular fibers.  Dystrophic and focal atrophic changes cardio-myocites were revealed in 74±0,8% of cases.  Diffusion and small focus growths of connecting fabric in an interstition and around vessels are noted in 39±0,2% of cases.  The uneven thickening of innder layers of coronary arteries of an average and small caliber owing to proliferation of cells of the inner layer with small focus of the lipomatosis is revealed in 69±0,5% of cases. In 57±0,3% of cases in vessels of the microcirculatory course dystrophic changes and a desquamation of the cells of the inner layer of blood vessels, increase of vascular permeability in the form of multiples mall focused hemorrhages through diapedesis, and also dystonia of walls of vessels in the form of an uneven spasm and vazoparesis are revealed.

The revealed pathologic-morphological changes of a myocardium and coronary vessels at addicts are caused by long toxic influence of narcotic substances and alcohol, and also a chronic hypoxia of fabrics, owing to angio-spasm. The degree of expressiveness of all revealed morphological changes depended on duration of the use of narcotic substances and the age of the dead. Therefore, the specified structural changes in a myocardium and coronary vessels are morphological markers of warm insufficiency of toxic genesis.


1       Поданева В. И., Абдраимов М. А., Жунисов С. С., Райымбердиева Ж. Ш. Анализ смертельных отравлений в г. Алматы за 1996-1999гг., //Судебная медицина в Казахстане, Алматы, — 2003 г, — № 7, — С. 40-41.

2       Алтаева А. Ж., Селивохина Н. В., Даирбекова Ж. Д., Ким О.Б., Поданева В.И., Жолумбетов О. О. Ретроспективный анализ смертельных комбинированных отравлений наркотическими веществами и алкоголем //Международный научно-практический журнал «Морфология и доказательная медицина». – Алматы, 2010, — №4. – С. 15-17.

3       Тойбаев Г. М. Токсикологическая ситуация по г. Алматы в период времени с 1999 по 2010 года // Вестник КазНМУ, Алматы, — 2012, (выпуск посвященный 1-й годовщине БСНП г. Алматы) — С. 76-85.

4       Пиголкин Ю.И., Должанский О. В., Голубева А. В. Судебно-медицинская диагностика хронической наркотической интоксикации по морфологическим данным // судебно-медицинская экспертиза. – Москва, — 2012, — №1, С. 34-37.

5       Hantson P., Beauloye C. Myocardial metabolism in toxin-induced heart failure and therapeutic implications // Clin. Toxicol (Phila). 2012 Mar; 50(3):166-71.

6       Kul´bitskiĭ B.N., Larev Z.V., Fedulova M.V., Denisova O.P., Bogomolov D.V. Pathology of the heart conducting system in the thanatogenesis of sudden death from alcoholic cardiomyopathy and coronary heart disease // 2012 Mar.-Apr;55(2):62-5.

7       Bogomolova I.N. Bogomolov D.V. Shpekht Dlu., Kul´bitskiĭ B.N. The characteristic morphological changes of the internal organs in certain forms of combined poisoning. 2012. 55 (2):18-21.



Ю. С. Исмаилова, А. Ж. Алтаева

Морфиндік нашақорлық кезіндегі кардиоваскуллярлы патоморфология

Түйін: Мақалада созылмалы есірткілік улану кезіндегі есірткі заттармен жедел уланудан өлген адамдардің миокард және тәжартерияларының патоморфологиялық зерттеулердің нәтижелері көрсетілген. Микроскопиялық зерттеу кезінде поляризациялық және өтуші шырақтық микроскопия әдістемелері қолданылды, соның барысында, нашақорлардың миокард және тәжартерияларында анықталған патоморфологиялық өзгерістер есірткі заттардің және арақтың созылмалы улы әсерінен пайда болған, яғни ангиоспазм нәтижесінде болатын созылмалы гипоксияға байланысты. Анықталған морфологиялық өзгерістердің дәрежесі өлген адамдардің есірткі заттармен қолдану мерзіміне және жасына байланысты болған.

Түйінді сөздер: сот-медициналық сараптау, есірткі заттармен жедел улану, есірткімен созылмалы улану, миокард және тәжқантамырларының патоморфологиясы.






Ю. С. Исмаилова, А. Ж. Алтаева

Кардиоваскулярная патоморфология при морфиновой наркомании

Резюме: В статье представлены результаты патоморфологических исследований миокарда и коронарных сосудов у лиц, умерших от острого отравления наркотиками на фоне хронической наркотической интоксикации. Микроскопическое исследование тканей сердца проводилось с применением проходящей световой и поляризационной микроскопии, при этом, выявленные патоморфологические изменения миокарда и коронарных сосудов у наркоманов были обусловлены длительным токсическим влиянием наркотических веществ и алкоголя, а также хронической гипоксией тканей, вследствие ангиоспазма. Степень выраженности всех выявленных морфологических изменений зависела от длительности употребления наркотических веществ и возраста умерших.

Ключевые слова: судебно-медицинская экспертиза, острое отравление наркотическими веществами, хроническая наркотическая интоксикация, патоморфология миокарда и коронарных сосудов.







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