Annals of Cardiovascular and Thoracic Surgery

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We present the case report of a 34-year-old Hispanic male who was found unresponsive within the carport of his residence. Surveillance video footage from a security camera showed that he collapsed as he was walking to his vehicle. The decedent had no medical record and no history of illicit drug use. Initial toxicology testing revealed no alcohol or illicit drugs. Autopsy findings indicated a requirement for extra toxicological analysis thanks to a scarcity of trauma and therefore the paucity of pathophysiologically significant natural disease. Liquid chromatography time-of-flight mass spectrometry of postmortem blood revealed the presence of two large peaks like desmethyl carbodenafil, an unapproved sildenafil analogue and its hydroxy metabolite.

The reference standard for desmethyl carbodenafil was obtained from TLC PharmaChem (Vaughan, Ontario, Canada). Diphenhydramine-D3 was purchased from Cerilliant Corporation (Round Rock, TX).

High performance liquid chromatography (HPLC) vials were obtained from Agilent Technologies (Santa Clara, CA). Ultra-filtered water (18.2 MΩ cm) was used throughout

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