Q: Under what circumstances can poppers (Amyl nitrite) kill a victim so it looks like natural death? If this is not possible in reality, could you provide a pseudo-medical explanation?
L. Mitana, Slovakia
A: Amyl Nitrite is what we call a vasodilator–meaning it opens up all the blood vessels in the body. Too much can lead to an immediate and profound drop in blood pressure (BP) and this can cause death directly from shock or indirectly by generating a cardiac arrhythmia due to poor blood flow to the coronary arteries. If the victim has coronary artery disease (CAD), this drop in BP can cause a heart attack (myocardial Infarction or MI). So, too much Amyl can definitely be lethal and do so in several ways.
At autopsy the coroner would see nothing unless the victim had CAD. Either way he might write the death off as a cardiac arrhythmia. If he did test for amyl nitrite he might find it or not–it is destroyed very quickly by the body’s enzyme systems but some might remain after death–or not. But he would not test for this unless he had some evidence that Amyl Nitrite might be involved in the death.
This same vasodilatory effect is why Viagra should not be taken with long-acting nitrates. Some people who suffer from CAD are prescribed long-acting nitrates to help relieve angina—chest pain due to poor blood supply to the heart muscle. Like Amyl, these nitrates and Viagra are vasodilators and when taken in combination can cause a dramatic decline in BP and death can follow.