Boy Sean S., I like your bringing in the history of the deaths occurring in-custody! Recognizing that I am NOT a pathologist or a cardiologist, I obviously can only try to synthesize what I have learned and seen over the years. When those individuals are found post mortem to have had multiple small heart attacks, the proximate cause is perhaps obscure but I absolutely think that the drug abuse has contributed. That would be particularly true with the use of cocaine and the likelihood is that a significant component or majority of drugs users in that demographic would have used coke at some time. There is a lovely article available on the internet from the American Heart Association in 2010. What is known is that coke is a sympathomimetic causing an increased level of catecholamines. This leads to increased level of vascular vasoconstriction (tightening or narrowing) as well as increased heart rate. The consequence of this is increased blood pressure and hence an increase in oxygen demand by the heart. This mimics but is profoundly stronger than the changes that occur when we experience "fight or flight." If the individual has coronary vessels on the lower end of the spectrum as far as caliber then it makes sense that further narrowing of those vessels could create isolated small areas of ischemic heart muscle leading to localized muscle death/heart attack. Likely there are many more individuals both athletes and non-athletes that are participating in this illegal and stupid activity that never end up having a noticeable heart attacks. The other thought that I have is perhaps off the wall but...........Is it possible that the frequent injection of drugs with poor technique, dirty needles and repetitive trauma to a vessel at a localized area causes endothelial inflammatory reaction leading to the formation of small, isolated clots. If this was so, should the clots break loose, they would travel to the right side of the heart only and not to the left side unless the patient had a patent foramen ovale, possibly a small atrial septal defect, both unusual in an active adult but not incompatible with an active life particularly when young. A thought only, no idea if this occurs or not. I do not know why the injected narcotics over time would not cause similar cardiac damage as occurs over time with alcoholics. Realistically, an inflammatory process is an inflammatory process and I would think the spike proteins produced by the mRNA "vaccines" would simply speed up the process that occurs with chronic use of cocaine in particular but also injected drugs and alcohol. Whatever the etiology, when the oxygen demand of the heart muscle exceeds the supply, muscle dies. If the muscle becomes inflamed without any particular limitation to oxygen supply, the v. fibrillation can occur because the spike protein has directly impacted the ability of the SA node, AV node, bundle branches to release timely impulses and carry them without delay to the ventricles. Also the inflammation of the ventricular tissue can apparently change the function of the ventricular muscle so that different cells will spontaneously fire leading to the v. fib. when a "normal heart" at that point would not have had the problem. Finally, if the heart is itself inflamed and not functioning totally normally then a good thump to the chest/heart certainly would have a greater chance of setting off v. fib. Good thinking on your part! Thank you!