most serious effect of heroin is to slow the rate of breathing, which may lead to respiratory failure and cardiac arrest - commonest cause of death in heroin users
Heroin also slows heart rate and lowers blood pressure through a combination of CNS and peripheral actions, and may be associated with pulmonary oedema
the most serious effects of heroin on the heart and blood vessels result from its mode of use – by injection – rather than from the drug itself. Intravenous injection of contaminated heroin can cause infective endocarditis, while groin injecting can lead to deep vein thrombosis
Reference:
British Heart Foundation (6/2003).Factfile - illicit drugs and the heart.
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