Is there a drug that can cause a heart attack without staying in the bloodstream?

With the obvious disclaimer that I've never actually poisoned anyone, Google offered up these wonderful little gems:

http://listverse.com/2012/12/02/10-poisons-used-to-kill-people/
http://parazite.nn.fi/roguesci/index.php/t-3971.html

You've gotta love the interwebz...

Possibly potassium.

veinglory said:

Possibly potassium.

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Nope, potassium is part of a standard postmortem blood panel.

As far as prescribed medication there is a significant number of drugs that can stop a heart, but all them are detectable, and all are hard to get a hold of without being caught. There's probably a number of illegal drugs that can stop the heart, but the ones I know of are traceable.

The way it could work is if it's a drug that someone doesn't expect to to be there. If its something that doesn't show up in a routine tox-screen or blood panel, and the ME doesn't have a reason to look for a specific metabolite then it might be missed.

If you watch crime shows a LOT and I'm sure you do, you will remember that arsenic is rarely checked for in a death. It is a long, slow death usually, but doctors are usually mystified by what is going on and don't even think to check for arsenic poisoning.

It's not a heart attack, but I once watched this crime show episode where this woman slowly killed her husband with antifreeze. It gave him flu-like symptoms, so no one was suspicious. It has sweet taste, so she just mixed it in with things like tea and jello (for when he was sick with the "flu.")

She would have gotten away with his murder, except she did the same thing with her second husband and that's when things got suspicious.

Foolonthehill said:

MMMhh arsenic sounds interesting, in fact I was thinking of having the killer place the drug in food, repeatedly.... but then how long would that take and wouldn't the victim be able to taste it? Plus would it cause a heart attack?

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The thing is that you risk the victim building up a tolerance. I want to say this was the plot of some show, or was a real world thing, in which case it ended up as the plot of one of the Law and Orders eventually.

Not that this would work for me, but if I wanted someone to die via heart attack I'd go with a medicine mix up.

MdShafer, it seems like I once read that there is a medicine used for treating heart failure (nitroglycerin, maybe?) that can be damaging/deadly if it is given to a healthy patient. It's been so long, though, that I can't remember the details. Is this accurate? And would that medicine show up on an autopsy?

I did see the antifreeze episode! It was EPIC!

Instead of poison, how about injecting air? Instant results, and very difficult to detect postmortem.

Another non-poison thought- what if they are purposely infused with the wrong blood type? I'm pretty sure that can be deadly - would it show up on an autopsy?

You could also induce a reaction in person with a severe allergy. If the victim has a severe allergy to, say, peanuts, his death might be assumed to be just a bad reaction to a cookie.

melindamusil said:

You could also induce a reaction in person with a severe allergy. If the victim has a severe allergy to, say, peanuts, his death might be assumed to be just a bad reaction to a cookie.

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Ooh,this is scary

melindamusil said:

MdShafer, it seems like I once read that there is a medicine used for treating heart failure (nitroglycerin, maybe?) that can be damaging/deadly if it is given to a healthy patient. It's been so long, though, that I can't remember the details. Is this accurate? And would that medicine show up on an autopsy?

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There are a whole host of HF meds that can harm a healthy person, especially if they're otherwise fragile. Most of the time if a healthy person takes Nitro the worst thing that will happen is that you'll get a headache, but it's a really bad headache.

I'm not an medical examiner, I don't know how they work, but I'm under the impression that all drugs can show up in a postmortem blood screen, but sometimes they have to be looked for specifically.

Forget chemicals; go natural.

Foxglove is natural digitalis and grows wild in several places. Wild tobacco is very toxic and can be mistaken for safer cooking ingredients. Poison mushrooms are viable mistakes, also with cooking.
Curare isn't easy to find, but it's a paralytic. Wolfsbane works on the heart, too.

There are probably hundreds of natural sources you could find, especially if it's going to be food-based.

The hard part of your question is in regard to the substance not being apparent in the blood. Cyla's suggestions would be fine, except for that ban. Arsenic stays in the body forever; there are even people who think that Napoleon might have been poisoned with arsenic, because it was found in his hair long after his death. If you can find something that acts like nicotine (that is interferes with the acetylcholine receptors) but would break down fast enough that it would not show up in postmortem examinations, then you might have what you want.

That's why I suggested natural sources. Even if they're detected, it's easy enough to say the poisoning was accidental - especially if it's a single dish made repetitively because it's the victim's "favorite." While the poison might be discovered, it's plausibly explainable. Foxglove would be a good one for that, if your victim lives near a place where it grows wild. A lot of people think of it as a weed; pulling the plants up bare-handed can crush the petals into the skin. It takes a lot of exposure for that sort of contact to be close to dangerous, but a slow build up *might* be hand-waveable.

There was actually a woman who nearly (and truly accidentally) poisoned her entire family with wild tobacco. She was making some kind of special stew for her young granddaughter's birthday party, and couldn't see well enough to differentiate the tobacco leaves from whatever it was she thought she was putting into the pot. The entire party ended up in the hospital, and it took several specialized blood tests to figure out what had made them all sick.

If you're wanting to use nicotine, then the easiest place to get it (short of a cigarette factory) would be a liquid insecticide.

Cyia said:

That's why I suggested natural sources. Even if they're detected, it's easy enough to say the poisoning was accidental - especially if it's a single dish made repetitively because it's the victim's "favorite." While the poison might be discovered, it's plausibly explainable. Foxglove would be a good one for that, if your victim lives near a place where it grows wild. A lot of people think of it as a weed; pulling the plants up bare-handed can crush the petals into the skin. It takes a lot of exposure for that sort of contact to be close to dangerous, but a slow build up *might* be hand-waveable.

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That sort of thing is plausible. Pokeweed which some people use to make poke salad is quite poisonous, but some parts are safe at certain times of the year.

There was actually a woman who nearly (and truly accidentally) poisoned her entire family with wild tobacco. She was making some kind of special stew for her young granddaughter's birthday party, and couldn't see well enough to differentiate the tobacco leaves from whatever it was she thought she was putting into the pot. The entire party ended up in the hospital, and it took several specialized blood tests to figure out what had made them all sick.

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I can't imagine anyone missing the fragrance of nicotine, but accidents do happen, and accidents with mushrooms happen fairly regularly. Actuall, I suspect that someone I know of may have used mushrooms to get rid of her husband, but there is no evidence, so it's just a story.

If you're wanting to use nicotine, then the easiest place to get it (short of a cigarette factory) would be a liquid insecticide.

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"In 2008, the EPA received a request, from the registrant, to cancel the registration of the last nicotine pesticide registered in the United States.[118] This request was granted, and since 1 January 2014, this pesticide has not been available for sale."
http://en.wikipedia.org/wiki/Nicotine#Use_as_an_insecticide

MDSchafer said:

I'm not an medical examiner, I don't know how they work, but I'm under the impression that all drugs can show up in a postmortem blood screen, but sometimes they have to be looked for specifically.

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I'm not even a doctor, but I'm pretty sure that every drug can be found in an autopsy; the trick is to not give the medical examiner a reason to look for that drug. If you have an old guy with a family history of heart disease who dies of an apparent heart attack, the ME will probably take that at face value. As long as there's no reason to suspect fowl play, the scheming widow will get away with it.

Cyia said:

If you're wanting to use nicotine, then the easiest place to get it (short of a cigarette factory) would be a liquid insecticide.

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I've heard about kids getting (accidentally) poisoned by the liquid nicotine used in e-cigarettes. It's highly concentrated and should be kept out of reach of curious young kids.

MDSchafer said:

There are a whole host of HF meds that can harm a healthy person, especially if they're otherwise fragile. Most of the time if a healthy person takes Nitro the worst thing that will happen is that you'll get a headache, but it's a really bad headache.

I'm not an medical examiner, I don't know how they work, but I'm under the impression that all drugs can show up in a postmortem blood screen, but sometimes they have to be looked for specifically.

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BUT, if you give someone a lot of Nitroglycerin, you can bottom their BP out and kill them. I have no idea if it shows up in the blood stream though. If it's an older person and they take erectile dysfunction medications (an have in the las5t 24-48 hours), nitro can kill them too.

The allergy suggestion someone else mentioned is pretty good, though I feel it's been done a lot. I would recommend your character goes the accident route (which can be quite creative) or pushes the victim to commit suicide. There are many ways to achieve this where the police wouldn't really investigate too much being that it was a suicide.

Certain illicit drugs could push a person to become suicidal as well and while it'd be noticed on a screening, it would be written off as a junkie who went nuts and offed themselves.

Buttercups! Wild buttercups are extremely toxic. I know they are everywhere here in my neck of the world.

One of the problems you have with natural ingredients is the sheer volume you have to use to cause death. Buttercups are toxic, but you'd have to eat an entire field to kill yourself (not to make you sick, but to actually kill you). There aren't that many plants with toxin so concentrated that it can kill you in small amounts. Yew seeds and leaves are one (http://www.nlm.nih.gov/medlineplus/ency/article/002877.htm) and the mortal dose is quite small (http://www.botanical-online.com/alcaloidestejoangles.htm) and it does grow in Europe. It causes slow heart rate and can cause death in 30 minutes.

Another one is Oleander (http://www.nlm.nih.gov/medlineplus/ency/article/002884.htm). It's a decorative plant that might be used in gardens, like foxglove.

A third natural option is castor bean, the source of ricin. It's a common decorative plant in gardens.

Someone here suggested injecting air--the problem here is that you need to inject about a liter of air to have it actually stop the heart.

Acetylcholine is an injectable that kills, and is naturally present in the body. It actually degrades after death, so if the medical examiner doesn't think to check for it really quickly, it's gone.

Another option is insulin. It's a commonly available injectable drug that an overdose is rarely detected, especially if the body takes a little while to be discovered. People test for blood sugar, not for the insulin itself. A body that takes several hours or a day to be discovered continues to chew up blood sugar, so it's ordinarily low in a postmortem blood sample of this kind.

Foolonthehill said:

MMMhh arsenic sounds interesting, in fact I was thinking of having the killer place the drug in food, repeatedly.... but then how long would that take and wouldn't the victim be able to taste it? Plus would it cause a heart attack?

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No arsenic is tasteless.

Also yes you can build a tolerance to it, but if a person just feeds someone a lot of arsenic at one go they will die.

snowpea said:

No arsenic is tasteless.

Also yes you can build a tolerance to it, but if a person just feeds someone a lot of arsenic at one go they will die.

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Arsenic is traditionally used as an oxide, which is as sweet as sugar. The lethal does is rather high. The acute minimal lethal dose of arsenic in adults is estimated to be 70 to 200 mg or 1 mg/kg/day.[14]
http://en.wikipedia.org/wiki/Arsenic_poisoning