Coroner: Chris Penn Died Accidentally

Thank you. He was a real good kid. He was valedictorian of his class-though he wasn't there to receive the honor. They had his cap and gown draped across his chair with his picture and his diploma. His team mates were his pall bearers.

Btw check out my tagline,small world Eh ?

Footloose is one of my all time favorite movies and he was great in it....

He was a pretty good actor, especially in "Reservoir Dogs". Anyone who saw him in one of his last roles, though, (Law and Order) could have predicted this. He was very overweight.

Sweet story. Prayers up for you nephew. I have a niece who is a Jewel. If I lost her I would be gutted with grief.

"We know he had several prescriptions, including promethazine with codeine, which featured predominantly in his death," Harvey said. Promethazine with codeine is known as a highly addictive prescription medication. Promethazine is an antihistamine that prevents vomiting, while codeine suppresses coughing and relieves pain, Harvey said.

Pure conjecture on my part, but I'm guessing he had undiagnosed sleep apnea (he sure had the build for it) and decided to pop a couple of extra pills because his allergies (or nausea, or whatever it was prescribed for) were unusually bad that day. But promethazine's pretty strong stuff, and mixed with codeine it's a major league CNS and respiratory depressant. (They won't even prescribe it for kids because it has the slightly unpleasant side effect of tending to cause them to stop breathing.) Toss in a beer or two before bed, and even a mild sleep apnea episode might make sure you never wake up again.

ooooooooooooooooops, i just overdosed.

Wild Life also had the great Bananarama song of the same name. It was a fun film. Personally, I think Chris Penn was a better actor than his brother, but I guess his weight always kept him on the C-list.

Favorite line from RepoMan has got to be, "Put it on a plate, son--it'll taste better that way..."

By the way, you have got, hands down, the coolest Freep Page ever!

POINTS FOR THE CAPTAIN & TENILLE DOLLS!!

I had a friend drop dead of this in '82. I'm not saying this is what got him, but I'm just sayin'...

Cardiomyopathy, Cocaine
Last Updated: October 26, 2004 Rate this Article
Email to a Colleague
Get CME/CE for article

Synonyms and related keywords: cocaine myocarditis, cocaine-induced heart failure, chronic cardiomyopathy, cocaine abuse, cocaine addiction

AUTHOR INFORMATION Section 1 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

Author: Paul A Janson, MD, Instructor, Tufts University School of Medicine; Director, EMT/RN Consultants; Staff Physician, Department of Emergency Medicine, Lawrence General Hospital
Coauthor(s): Carla Vaccaro, MD, Fellow, Department of Family Practice, Memorial Hospital of Pawtucket and Brown University; Camille Michals, LSW †, Former Licensed Social Worker, Department of Social Services, Lawrence General Hospital

Paul A Janson, MD, is a member of the following medical societies: American Academy of Emergency Medicine, and American College of Emergency Physicians

Editor(s): Gary E Sander, MD, Professor, Department of Internal Medicine, Division of Cardiology, Louisiana State University School of Medicine and Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center; Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital; and Michael E Zevitz, MD, Clinical Assistant Professor, Department of Medicine, Rosalind Franklin University of Medicine and Science

Disclosure

INTRODUCTION Section 2 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

Background: Cocaine abuse is a significant problem in the United States and worldwide. The effects of this epidemic are numerous, including medical, psychosocial, and economic. Among the medical consequences, the cardiac effects of cocaine use are well described. Most of the information deals with acute toxicity. However, the fact that subacute or even chronic cardiomyopathy may result from the use of cocaine is being increasingly recognized. While most cases have proved to be reversible, others have gone on to result in death or permanent cardiac dysfunction.

Pathophysiology: The effect of cocaine on cardiac muscle and coronary vessels remains poorly understood. In acute cocaine exposure, the vasoconstrictive action of the drug seems to be the predominant effect. Both coronary vasoconstriction resulting in myocardial ischemia or infarction and systemic vasoconstriction resulting in hypertension or organ ischemia (particularly cerebral) are observed. Cocaine is known to block the reuptake of norepinephrine and dopamine at preganglionic sympathetic nerve endings, and this action of cocaine is presumed responsible for the increase in heart rate and blood pressure and the acute vasospastic syndromes observed in individuals who use cocaine. Pathologic similarities between cocaine cardiomyopathy and those seen in pheochromocytomas suggest that chronic adrenergic stimulation may play a role in the development of cocaine cardiomyopathy.

Cellular effects that have been suggested include changes in calcium flux that are similar to other cardiac toxins, including digoxin. Increased intracellular concentrations of calcium have been suggested as a cause of depolarization of the cardiac membrane and, therefore, a trigger of sustained action potentials, extra systoles, and tachycardia (sinus, supraventricular, or ventricular). This effect may be present with acute cocaine use. Also, a high concentration of calcium may decrease myofilament responsiveness.

Decreased calcium concentrations may occur later in the course of cocaine use and result in depressed myocardial function. A local anesthetic action also is observed, similar to lidocaine, which can acutely depress myocardial contractility. Several studies demonstrate that chronic cocaine use has a direct depressive effect on left ventricular function. This effect seems to be independent of myocardial blood flow and coronary artery diameter.

Regarding the subacute and chronic cardiomyopathies, a clear association has been made with ischemic cardiomyopathy and cocaine use. Regional wall motion abnormalities can be observed, even in patients with no history of myocardial infarction. This syndrome is characterized by evidence of multiple infarcts with normal coronary arteries upon catheterization. This is presumed to be present because of vasospasm or thrombosis. Cocaine use has been shown to increase platelet aggregation and to lead to thrombus formation.

This syndrome, cardiac failure due multiple infarcts, is distinct from true cocaine cardiomyopathy, which shows global myocardial dysfunction. Both entities may be associated with normal coronary arteries or minimal atherosclerotic disease. The situation is further complicated by reports of left ventricular aneurysm formation with embolization in patients with cocaine cardiomyopathy. Whether these cases represent cocaine cardiomyopathy or ischemic cardiomyopathy due to cocaine is unclear. The presence of both entities in the same patient also is theoretically possible.

Frequency:

In the US: Cocaine use in the United States has been reported to be as high as 5 million regular users, with as many as 30 million with a history of past use. The reports of cardiomyopathy are case reports, which would seem to imply that it is an infrequent result of cocaine use and may represent an idiosyncratic reaction. The true incidence of cardiomyopathy may be substantially underreported. Felker et al reported 1278 cases of dilated cardiomyopathy treated at Johns Hopkins; only 10 were ascribed to cocaine use.
Mortality/Morbidity: The morbidity and mortality associated with cocaine-induced cardiomyopathy is based on case reports and therefore may be underreported. Many deaths in the drug abuse population are ascribed to drug toxicity without further attempts at defining the exact etiology.

Race: At present, no increased susceptibility has been reported in any racial group.

Sex: No sexual predilection has been reported.

Age: The distribution of cocaine cardiomyopathy generally follows the distribution of cocaine use. The majority of cases are reported in the 30- to 40-year age group, with additional patients being somewhat older and somewhat younger.

CLINICAL Section 3 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

History: Patients who use cocaine may have a variety of symptoms referable to the cardiac system. Symptoms may include chest pain with or without myocardial ischemia or aortic dissection, hypertension with or without hypertensive crisis, cerebral ischemia, and hemorrhage. This may result in symptoms of headache and stroke. Patients also may present with acute myocardial decompensation with or without pulmonary edema and shock. In this case, shortness of breath and hypoperfusion dominate the clinical picture.

Myocardial ischemia or infarct
Symptoms of chest pain may be of muscular origin but may represent ischemia or infarct.
Associated symptoms of myocardial ischemia/infarct usually are present, including diaphoresis, nausea/vomiting, dyspnea, and a sense of impending catastrophe.
In patients presenting with chest pain, aortic dissection also should be considered.
Symptoms of congestive heart failure
The symptoms of cocaine cardiomyopathy are the same as symptoms for other forms of congestive heart failure. The onset may be very sudden and of short duration.
Many patients present in shock and require intubation and vasopressors at the time of presentation.
A history of myocardial infarction (due to cocaine-induced vasospastic ischemia) may be present but often is absent.
Symptoms of chronic congestive heart failure usually are absent, but a history of prior congestive heart failure related to cocaine use may be present.
History of cocaine use
A history of cocaine use is a requirement for establishing the diagnosis. This etiology of cardiomyopathy should be suspected in any patient with a history of cocaine use, particularly binge use, and heart failure without another established etiology such as coronary artery disease.
The clinician should suspect this in any patient with appropriate presentation, particularly in a patient who is younger than would be expected to have atherosclerotic cardiovascular disease.
Evidence of drug use (needle tracks, perforated nasal septum) should raise clinical suspicion.
While direct questioning of the patient may yield the necessary information, if the clinical suspicion is high, the diagnosis of cocaine use should be investigated further, perhaps with a urine screen for cocaine and its metabolites.
Appropriate age
Patients in the case reports usually are aged 30-40 years, although both older and younger patients are common. This is younger than would be expected for a diagnosis of ischemic cardiomyopathy, but viral, toxic, or idiopathic etiologies (including postpartum) are well within this age range.
Older patients should be considered if other etiologies are not apparent.
Physical:

Acute adrenergic findings
Cocaine intoxication usually presents with symptoms of adrenergic excess. Hypertension, occasionally in the range of hypertensive crisis, may be present. Cerebral vascular accidents of either thrombotic or hemorrhagic origin are not uncommon. Acute delirium and mania may be present, particularly if other drugs were used concurrently.
Tachycardia and arrhythmias also occur, particularly atrial fibrillation and premature ventricular contractions. Ventricular tachycardia and fibrillation also are observed. Acute chest pain syndromes are common and may be due to chest wall pain syndromes or acute myocardial ischemia or infarct.
Finally, an increased incidence of aortic dissection and rupture also occurs and must be included in the differential diagnosis. The clinician should search for the appropriate physical findings in these cases.
Findings of acute congestive heart failure
With acute binge use, the patient may present with acute congestive heart failure and pulmonary edema. Hypotension, rather than hypertension, may predominate and makes the diagnosis and treatment more difficult.
Cocaine cardiomyopathy presents more acutely than other types of congestive heart failure, and fewer findings of chronic congestive heart failure are present. Otherwise, the physical findings are similar.
Diaphoresis, pallor, and acute dyspnea are present. Cardiogenic shock or evidence of cardiac ischemia also may be present.
Findings related to drug abuse
If cocaine has been used intranasally, septal perforation and other signs of cocaine abuse may be present.
Needle tracks and other skin changes may be seen, consistent with intravenous drug use.
Psychologic changes of paranoid ideation may be present and may make management more difficult.
Endocarditis
Bacterial endocarditis may accompany cocaine use if the drug was used intravenously.
The clinician should search for evidence of valvular dysfunction, possibly acute, and embolic disease.
Causes:

Cocaine use is the principal cause, and the diagnosis cannot be made in its absence. Other contributing etiologies have been suggested, including contaminants and vitamin deficiencies associated with use of "street" drugs.
Adulterants
No cases have been reported following therapeutic use of cocaine.
Other agents, particularly adulterants in the street drug, have been suggested as contributing to this syndrome, including arsenic, magnesium, and others.
DIFFERENTIALS Section 4 of 10
Author Information Introduction Clinical Differentials Workup Treatment Medication Follow-up Miscellaneous Bibliography

Penn appeared in such films as "Reservoir Dogs," "Rush Hour," "Starsky & Hutch" and "Corky Romano."

Of the 4 movies listed in this article, the only one I saw was "Rush Hour".

I've never heard that, my kids have all had promethazine with codeine, prescribed by doctors; my sister's kids too. It's an excellent cough medicine when one has the kind of cough that just won't stop. It's not something we use often, maybe just once in a year, but it's worth its weight in gold rather than being up all night coughing.

I should have been more clear: I meant really little kids, like 2 or 3. It's also a pretty recent thing; it just got hit with a black box warning about a year and a half ago.

He was very overweight.

I was blown away by that too, especially after seeing that picture of him from "All The Right Moves" posted in this thread.

And "Pale Rider", a role he did quite well, BTW.

I had completely forgotten about that one. You're right, he did do a fine job in that role.

In other words: Accidental Overdose.

In some other words: Toot Gone Wrong....

I blame Dick Cheney.

Along with Sidney Penny. MEOW!!!
Do you think they will investigate the doctors who gave him all the prescription medication?
Calling Rush....

I didn't know Chris Penn was black.

Favorite line from RepoMan has got to be, "Put it on a plate, son--it'll taste better that way..."
Nope best line was:
" What about our relationship?"
"Relationship, F*** that!"
"I'm glad I tortured you!"

I only saw it about 1000 times when I was in the Air Force!
A dorm favorite!