No full-text available
To read the full-text of this research,
you can request a copy directly from the author.
POSTMORTEM STUDY OF HISTOPATHOLOGICAL LESIONS OF HEART IN CASES OF SUDDEN DEATH - AN INCIDENTAL FINDINGS
Abstract
OBJECTIVE
To study the histopathological lesions of Heart in cases of sudden death.
METHOD
During the period from 1st
July 2014 to 30 November 2015, out of 144 medicolegal autopsies, 120 autopsies of heart were
received. Five specimen of heart were autolyzed so 115 autopsy specimen of heart were included for study. Routine H and E
staining is used for microscopic examination.
RESULT
Out of 115 cases, 74 cases shows atherosclerosis, 33 cases shows features of myocardial infarction, myocardial hypertrophy
found in 60 cases, 11 cases shows myocarditis, vaso-occlusive crisis in sickle cell was present in 6 cases and pericarditis present
in 1 case. In 29 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was
performed.
CONCLUSION
It was concluded that myocardial infarction due to atherosclerotic ischaemic heart disease is probably the commonest diagnosis
made in majority of sudden death cases subjected to medicolegal autopsies. Histological findings must be evaluated with great
attention for preventing incorrect conclusion to identify causes of deaths in sudden death cases.
... The corresponding figures were 73% and 85.21% in their studies by Ozdemir B et al, and Joshi C et al, respectively. 7,8 In this study maximum number of cases were between 21 to 30 years (27.06%) that is one decade earlier than the study done by Agale V. Shubhangi et al. 9 In gross examination, the average weight of heart in post fixation state was 288.62 gms whereas it was found to be Out of 133 cases, ventricular wall hypertrophy was found in 79 (59.39%) cases. Of the 79 cases biventricular hypertrophy found in 40 cases (50.63%) and left ventricular hypertrophy in in 30 cases (37.97%). ...
... Of the 79 cases biventricular hypertrophy found in 40 cases (50.63%) and left ventricular hypertrophy in in 30 cases (37.97%). Joshi et al. 8 also reported biventricular hypertrophy in 52% cases and left ventricular hypertrophy in 30% cases which is very similar to our study. Myocardial hypertrophy was also reported by Shanthi et al., 11 Cristina Basso et al., 12 and Bora et al. 7 in their studies. ...
... Chandrakala Joshi (64%) and Ekta Rani et al (77.3%) have shown atherosclerosis to be the commonest finding in their studies. 8,13,14 Out of 96 cases of fatty tissue infiltration, 17.7% cases showed fatty tissue infiltration in left ventricle within myocardial fibres, pericoronary area and in epicardium. Physiological Cardiac fat mainly present in the right ventricle in more than 50% of healthy individual and only a small amount is found in left ventricular wall in the region of apex. ...
Regardless of the suspected cause of death, the post-mortem examination should always be done where deaths (related to sudden and unexpected demise), come under the jurisdiction to determine the cause and manner of the death. Various incidental findings are identified during microscopic examination which may or may not be the contributing factor for cause of death. This findings may have been a great learning tool for pathologists. So, an autopsy study of heart was conducted to find out the various histopathological changes.
To study the spectrum of histomorphological changes in heart in autopsies.
The study was conducted in the Department of Pathology, North Bengal medical college, West Bengal for a period of 2 years from August 2021 to August 2023. Total 143 autopsy specimen was received during this period, specimen of heart received were 139, 06 were autolysed. So 133 specimens of heart were examined macroscopically and microscopically to see the different histopathological findings.
In our study most of the heart received in the age group of 21 -30 yrs. 72.1% cases showed fatty tissue interposition, 59.4% showed myocardial hypertrophy, 39.8% showed myocyte fibrosis, 31.57% showed inflammatory infiltration within myocyte, 22.5% showed atherosclerosis and thrombus within coronary vessels found in 6.7%.
The most common finding in our study is fatty tissue interposition within myocyte which differs from previous studies which showed atherosclerosis as the most common findings.
... The autopsies can be a valuable source for epidemiological information in addition to providing valuable information to deceased immediate family. 2 It is reported that concordance between clinical and pathological cause of death are moderate and autopsy still provides a very important procedure for evaluating causes of death. 2 Many a time it has been found that when gross pathology could not help to evaluate the cause of death, histopathology can conclusively opine the involved cardiac pathology. ...
... 2 It is reported that concordance between clinical and pathological cause of death are moderate and autopsy still provides a very important procedure for evaluating causes of death. 2 Many a time it has been found that when gross pathology could not help to evaluate the cause of death, histopathology can conclusively opine the involved cardiac pathology. ...
... Similar findings were reported by Ramazan Karanfil et al, 17-78 years and Chandrakala Joshi 41-60years. 2,4 This shows that age is a powerful risk factor for heart disease. The development of atherosclerosis increases markedly with age up to an age of about 65. ...
Background: Objective was to study the histopathological spectrum of heart diseases in autopsy specimens, that play a major role as cause of death.Methods: During the period from October 2015 to October 2017. Total 170 medicolegal autopsies were received during this period. Out of 170, specimens of heart were 150. Nine specimens were autolyzed. So, 141 specimen of heart were included in the study. Gross and microscopic findings on H and E stained sections were studied.Results: out of 141 cases, 78 cases showed atherosclerosis, 20 cases showed features of myocardial infarction, myocardial hypertrophy was found in 10 cases, 5 cases revealed myocarditis, pericarditis in 4 cases and one case each of infective endocarditis and aortic stenosis. In 22 cases, there was no identifiable cause of death even after complete gross and microscopic autopsy was performed.Conclusions: Myocardial infarction due to atherosclerosis is probably the commonest finding in death cases subjected to medicolegal autopsies.
... and pathological cause of death are moderate and autopsy still provides a very important procedure for evaluating causes of death. 3 Many a times it has been found that when gross pathology could not help to evaluate the cause of death, Histopathology can conclusively opine the involved cardiac pathology. ...
... In comparison of histopathological findings in our study, coronary atherosclerosis was most common finding present in 44% cases. Similar findings were observed in Joshi C, Karanfil [3][4][5][6][12][13][14] The next common lesion in present study was myocardial infarction and myocardial hypertrophy with atherosclerosis constituting 8% each. Similar incidence was reported by Basso C et al 12 and Wang HY et al. 15 Myocarditis was found in 8% of the total cases. ...
... Our results were similar to previous articles in that cardiovascular pathologies were the most common cause for SND, and frequency of cardiovascular causes in our study was 39.5%. 5 Myocardial infarction due to atherosclerotic ischemic heart disease is probably the commonest diagnosis made in majority of sudden death cases subjected to medico legal autopsies. 5 In this study also myocardial infarction was the most common cardiovascular cause of death. ...
... Our results were similar to previous articles in that cardiovascular pathologies were the most common cause for SND, and frequency of cardiovascular causes in our study was 39.5%. 5 Myocardial infarction due to atherosclerotic ischemic heart disease is probably the commonest diagnosis made in majority of sudden death cases subjected to medico legal autopsies. 5 In this study also myocardial infarction was the most common cardiovascular cause of death. A high sensitivity rate (71.9%) was found in diagnosing coronary arterial disease by gross diagnosis. ...
BACKGROUND
Autopsies are great tools of learning for the pathologists. They shed light into
the pathological processes that lead to the death of the person. This study was
undertaken to determine the age and gender distribution of the deceased
individuals according to the cause of death and compare the histopathological
diagnosis with gross diagnosis.
METHODS
All 304 autopsy specimens received in histopathology lab for a period of 2 years
were reviewed. Autopsy records, clinical case notes, gross specimens and
histopathological slides were retrieved, wherever available. The results were
analysed based on gross findings and histological examination. Histopathological
findings were noted. Data was analysed using the SPSS (Statistical Package for
the Social Sciences) software. Age and gender distribution, frequency of
histological findings, causes of deaths and number of histological findings
according to body systems were tabulated.
RESULTS
The present study showed that, 212 cases were males and 92 cases were
females. Pathology of highest percentage of cases was detected in
cardiovascular system (39.5%) followed by respiratory system (12.2%).
Myocardial infarction was seen in 12.8% cases, pneumonia in 9.2%, cirrhosis of
liver in 4.9%, coronary occlusion/narrowing in 10.5%, myocarditis in 11.5%, and
pericarditis in 2%. Some of the other pathological findings noted were
tuberculosis, burns, pancreatitis, meningitis, encephalitis, cardiomyopathy,
gastric ulcer, gangrene intestine and sacrococcygeal teratoma.
CONCLUSIONS
Histopathological analysis has an important role in determining the cause of
death. Co-existing morbidities and rare diseases may be diagnosed at the time of
autopsy which was not diagnosed ante mortem.
... were female with male to female ratio of 2.1:1. The study done by Dr. Chandrakala joshi et al [8] showed that, out of 115 cases, 98 (85.22%) were male and 17 (14.78%) were female with male to female ratio of 5.7:1, The study done by Ali derya azmak et al [9] showed, out of 278 cases of sudden unexpected death, 232 (83.4%) were male and 46 (16.5%) were female with male to female ratio of 4.3:1. ...
... In the study done by Arun Puri et al [10] the most common single cause of death was atherosclerosis which account for 24.8% out of 125 cases of sudden death. The study done by Dr. chandrakala joshi [8] et al showed that out of 115 cases died of cardiovascular causes, 74 cases (64.34%) were died of atherosclerosis, The study done by Bora Ozdemir et al [5] showed that out of 228 cases died of cardiovascular causes, 96 cases (42.1%) were died of coronary atherosclerosis. The study done by Dr. Love R. Bhagora et al [3] showed that out of 158 cases died of cardiovascular causes, 125 cases (46.82%) were due to coronary artery disease. ...
... The main objective of the autopsy is establishment of final diagnosis and determination whenever possible, of the cause of death [3] . It is reported that concordance between clinical and pathological cause of death are moderate and autopsy still provides a very important procedure for evaluating causes of death [4] . Many a time, it has been found that when gross pathology could not help to evaluate the cause of death, histopathology can conclusively opine the involved cardiac pathology. ...
... In present study, most of cardiovascular deaths occurred within age range of 31-60 years. Similar findings were reported in other studies [4,11] . This shows that age is a powerful risk factor for heart disease. ...
... Age emerges as a signicant risk factor for heart disease development, with the likelihood increasing with age. These observations align with previous studies demonstrating a similar male predominance, distribution across age groups, and the inuence of advancing age on 5 sudden cardiac death, as noted by Chandrakala Joshi., and . reported a prevalence of 75%, Chandrakala Joshi 64%, 14 15 Dhankar Khare et al. 61.5%, and Patel et al. 27%. ...
Introduction: There has been a signicant rise in cardiac-related casualities globally during the last few decades, especially among urban population. In India, ischemic heart disease has become prevalent, affecting roughly 10% of the population. The role of pathologist is to study the various disease process which lead to death and to establish the cause of death. Autopsies are crucial in evaluating the underlying causes responsible for such mortalities. As post-mortem analysis of heart is the the main diagnostic tool to study gross and histopathological changes in healthy or diseased heart, an autopsy study of heart was therefore planned to observe various histopathological changes. Aim and Objectives: The objective of this research was to examine the histomorphological characteristics of different heart lesions, including both gross and microscopic observations, in heart specimens obtained post-mortem at the Department of Pathology, RNT Medical College, Udaipur, over a one-year period. A prospective study was conducted in the Materials and Methods: department of pathology, RNT Medical College Udaipur over a period of one year. We examined a total of 157 autopsies, regardless of the cause of death, with 7 cases being too autolyzed for inclusion. Therefore, our study included 150 whole heart specimens. These specimens underwent gross examination, and microscopic sections stained with H&E were analyzed to identify various histopathological alterations. The observed ndings were then clinically correlated. Atherosclerosis Results: emerged as the predominant cardiac lesion, evident in 67 out of 150 autopsied hearts (44.66%), followed by ischemic heart disease observed in 26 cases (17.33%). Myocardial hypertrophy was present in 21 cases (14%), while myocarditis was noted in 6 cases. Additionally, changes indicative of electrocution were found in 2 cases, tuberculosis in 3 cases, stenosis of the aortic valve in 4 cases, and metastasis from lung carcinoma in 1 case. Age-related alterations were detected in 15 cases, while congestion was observed in 19 cases. Two cases each of rheumatic heart disease and congenital anomalies were also identied. Notably, the cause of death remained undetermined in 47 cases (31.33%) despite comprehensive macroscopic and microscopic examination. Among the major vessels, the left anterior descending artery was the most frequently affected (37.31%), followed by the right coronary artery (32.83%) and the left circumex artery (29.85%). Of the three major vessels, 18.37% exhibited single-vessel involvement, while 34.32% and 47.31% of cases showed involvement of two and three vessels, respectively. Correlation analysis between age and atherosclerosis revealed a signicant p-value of less than <0.05. Although males exhibited a slightly higher prevalence of atherosclerotic changes, the difference was not statistically signicant. Conclusion: Ischemic heart disease emerged as the predominant cause of morbidity and mortality within our society, with atherosclerosis being the prevailing observation. The most frequent pattern of involvement was identied as three-vessel disease
... The findings were in accordance with published studies. [15,16] Renal system was the second m.c system involved and ATN as the leading diagnosis, as already discussed above. Also it is the m.c cause of acute renal failure. ...
Background-The current study aims to highlight the importance of autopsies in not just finding the causeof death; but also, incidental discovery of various rare lesions, that may or may not be the cause of death.The study also aims to highlight the common cause of death, spectrum of common incidental findings andreporting of various rare, interesting cases. Method- This is a retrospective study conducted between year2013 to 2020 on 800 autopsies and their histopathological examination in Pathology Department, GMC,Patiala. Conclusion- Finding of this study concludes the importance of histopathological autopsy in not justhighlighting the cause of death but also finding many rare diseases, thus enriching the field of medicine andpathology by observing the histological findings and also sometimes the course of rare diseases.
... 22 Comparando la histopatología con otras series, la presencia de coronariopatía esclerótica fue uno de los hallazgos más frecuentes asociado con los diagnósticos finales de infarto del miocardio y de cardiopatía isquémica crónica complicada, similar a lo reportado por Joshi, C y col. 23 con una frecuencia de Medicina y Cirugía de ateroesclerosis coronaria hasta de 64% y Garg y Hasija 15 quienes reportaron una frecuencia del 55%, un poco menor de nuestros resultados. En los diagnósticos de infarto del miocardio y cardiopatía isquémica crónica complicada se observó en pocos casos la presencia de mastocitos, los cuales almacenan y liberan una variedad de mediadores biológicamente activos involucrados en la remodelación del miocardio, incluidas histamina, TNF-α, triptasa, quimasa y los factores de crecimiento como el TGF-β; la presencia de estas células concuerda con resultados publicados antes por otros autores. ...
Introducción: un evento de muerte súbita supone un gran impacto para la sociedad, siendo importante su estudio para aportar conocimiento y fortalecer estrategias de promoción y prevención. Objetivo: determinar la prevalencia de los diagnósticos anatomopatológicos cardiacos definitivos y los hallazgos histopatológicos asociados con la muerte súbita de origen cardíaco en los pacientes sometidos a autopsias clínicas realizadas en el Hospital de San José de Bogotá DC, Colombia, durante el período 2015 a 2018. Métodos: estudio descriptivo de corte transversal retrospectivo en pacientes a quienes se les realizó autopsia con diagnóstico de muerte súbita de origen cardiovascular en el servicio de patología del Hospital de San José, Bogotá DC, Colombia. Resultados: se incluyeron 178 autopsias con diagnóstico de muerte súbita cardíaca. El promedio global de edad fue 56.1 años (DE: 15.06) con una relación hombre-mujer de 3:1. El hallazgo macroscópico más frecuente fue cardiomegalia (promedio 428.1 g (DE 112.8), acompañado de la presencia de coronariopatía esclerótica (p=0.000) con obstrucción de la luz de las arterias coronarias mayores de 80% (p=0.037). Conclusiones: los diagnósticos anatomopatológicos definitivos prevalentes en la muerte súbita cardiaca fueron cardiopatía isquémica crónica complicada (65%) e infarto agudo de miocardio (16%), datos similares a los reportados a nivel mundial. La cardiomegalia es un hallazgo frecuente que debe valorarse en forma cuidadosa.
... 22 Comparando la histopatología con otras series, la presencia de coronariopatía esclerótica fue uno de los hallazgos más frecuentes asociado con los diagnósticos finales de infarto del miocardio y de cardiopatía isquémica crónica complicada, similar a lo reportado por Joshi, C y col. 23 15 quienes reportaron una frecuencia del 55%, un poco menor de nuestros resultados. En los diagnósticos de infarto del miocardio y cardiopatía isquémica crónica complicada se observó en pocos casos la presencia de mastocitos, los cuales almacenan y liberan una variedad de mediadores biológicamente activos involucrados en la remodelación del miocardio, incluidas histamina, TNF-α, triptasa, quimasa y los factores de crecimiento como el TGF-β; la presencia de estas células concuerda con resultados publicados antes por otros autores. ...
Introduction: a sudden death incident has a great impact on society and its study is important to provide understanding for strengthening promotion and prevention strategies. Objective: To determine the prevalence of definitive anatomopathological cardiac diagnoses and histopathological findings associated with sudden death due to a cardiovascular cause based on autopsies performed at Hospital de San Jose in Bogota DC, Colombia, during the period between 2015 and 2018.
Methods: a retrospective descriptive cross-sectional study of cases of sudden cardiac death of cardiovascular origin diagnosed in autopsies performed at the pathology service of Hospital de San Jose, Bogota DC, Colombia.
Results: 178 autopsies with a diagnosis of sudden cardiac death were included. The overall mean age was 56.1 years (SD: 15.06). Male/female ratio was 3:1. The most frequent macroscopic finding was cardiomegaly (average 428.1 g (SD 112.8), with the presence of sclerotic coronary artery disease (p=0.000) with a blockage greater than 80% (p=0.037) in the major coronary arteries.
Conclusions: the prevalent definitive anatomopathological diagnoses in SCD were complicated chronic ischemic heart disease (65%) and acute myocardial infarction (16%). Data obtained in this study is similar to that reported worldwide. Cardiomegaly is a frequent finding that should be carefully evaluated.
... Garg S et al (55.3%) and Joshi C et al (64%). [13][14][15] In terms of frequency of involvement and secondary changes LAD was most commonly involved vessel, followed by LCA and RCA. These findings are in concordance with studies done by Shah SN et al with LAD as most frequently involved vessel (38.70%) followed by LCA (36.56%) and RCA (31.18%). ...
Cardiac lesions are responsible for approximately 60-70% of sudden deaths. Histopathological examination of heart on autopsy plays an essential role in determining the cause of death.
The present study was conducted to analyse histopathological spectrum of various cardiac lesions in autopsy specimens.
This retrospective randomized study was conducted in the Department of Pathology, Pt. B. D. Sharma, PGIMS, Rohtak, Haryana. A total of 1152 autopsies were analysed, irrespective of cause of death. Among them heart was included in 1062 autopsies, out of which 62 were autolysed. Hence, 1000 specimen of whole heart were included in our study. A detailed gross and microscopic examination was done and histopathological findings were correlated clinically.
Atherosclerosis was the most common cardiac lesion seen in 610 out of 1000 autopsied heart (61%), followed by ischaemic heart disease in 346 cases (34.6%). 27 cases had pericarditis, 23 cases revealed myocardial hypertrophy, 16 cases showed myocarditis, 11 cases had ventricular haemorrhage, 8 cases revealed changes of electrocution, 7 cases had tuberculosis, 6 cases had calcification of valve and 4 cases had metastasis from carcinoma. One case each of infective endocarditis, rheumatic heart disease and aortitis were also noted. The cause of death was not identified in 304 cases. Left anterior descending artery was most frequently involved vessels (35.02%) followed by left circumflex artery (33.41%) then right coronary artery (31.57%). Out of three major vessels 16.24% had single vessel involvement whereas 32.14% & 51.62% cases had two vessels and three vessels involvement respectively.
Ischemic heart disease with coronary artery atherosclerosis was found to be the leading cause of death with triple vessel disease as the most common pattern of involvement.
... which is comparable to other studies done by Chandrakala Joshi et al (64%) and Garg S et al (55.3%). 12,13 Secondary changes like calcification was present in 48(51.61%) and thrombus formation in 10(10.75%) ...
... Similar ndings have been reported by et al (55.3%), Garg Chandrakala Joshi (64%) and al (77.3%) have shown atherosclerosis to be the Ekta Rani et commonest nding in their studies 4,5,6 Patchy areas of brosis of myocardium were seen in 5 cases. The brosis could be because of old healed infarction or inammatory causes. 2 cases showed necrosis of myocytes which again could be due to myocardial infarction. ...
BACKGROUND: Cardiovascular diseases are the leading cause of death in the world. Many pathologies are picked up
only on histomorphological evaluation after a meticulously done autopsy, hence establishing the cause of death.
AIMS & OBJECTIVES: The aim was to study the histomorphological patterns of cardiac lesions on autopsy.
MATERIAL & METHODS: 52 cases which showed changes in heart on histopathology from a total of 408 cases were analysed retrospectively
for age and sex distribution, clinical details and various types of lesions on histopatholgy.
OBSERVATIONS & RESULTS: Atherosclerosis was the most common nding seen in 61.5% of cases. Rare and incidental ndings on
histomorphology such as Giant cell myocarditis, Electrocution, metastatic carcinoma and tuberculosis were also seen.
CONCLUSION: The study describes different types of lesions seen on histopathology in the heart. Incidental lesions noted helped in infering the
cause of death.
context: Evaluation of cardiac autopsy specimens is crucial for identifying concealed cardiovascular pathology and providing insights into the pathogenesis and progression of disease. Hence, this study was undertaken to evaluate the histopathological features of cardiac lesions in autopsy specimens. method: The was a prospective cross-sectional study conducted on cardiac specimens from routine autopsies over a period of three and half years, between January 2018 and June 2021, at M.S. Ramaiah Medical College and Hospitals, Bengaluru. The hearts were evaluated grossly and microscopically to identify the various histopathological changes. results: A total of 250 cases, with mean age of 39±15 years and male-female ratio of 4.4:1, were evaluated. In 207 (82.8%) cases 299 morphological lesions were identified, comprised of coronary atherosclerosis (52.4%), myocardial infarction (26%), aortic atherosclerosis (21.2%), cardiac hypertrophy (12%), valvular disease (2%), aortic dissection (2%), cardiac tamponade (1.6%), pericarditis (1.2%), myocarditis (0.8%) and cardiomyopathy (0.4%). conclusion: Cardiac lesions were detected in 82.8% in autopsies. The most frequent finding is coronary atherosclerosis with triple vessel involvement being the commonest. Severe luminal occlusion, calcification and thrombosis are most frequent in Left anterior descending coronary artery. The next most common lesion is Myocardial Infarction, the most significant pathogenetic mechanism of which is coronary atherosclerosis. There is a strong association between coronary and ascending aorta atherosclerosis. Thus, many preventable and concealed lesions are discovered at cardiac autopsies and this data is important for assessing disease trends and introducing new interventions and therapeutic management regimes
Introduction: Sudden Cardiac Death (SCD) is a serious health concern, and the incidence of SCD is rising globally. A number of causes can result in SCD in apparently healthy individuals and in people with undiagnosed cardiac disease. The study was done to evaluate the probable cause of death by observing various histomorphological changes in cardiac autopsies.
Aim: To establish the cause of SCD and study the histopathology, age and sex distribution, frequency, and location of different types of cardiac lesions.
Materials and Methods: The study was a descriptive, cross-sectional, observational study carried out in the Department of Pathology and Forensic Medicine and Toxicology (FMT) at PRM Medical College and Hospital, Baripada, Odisha, over a period of three years. Gross and microscopic findings on Haematoxylin & Eosin (H&E)-stained cardiac sections were studied. The final diagnosis was made on the basis of clinical, autopsy, and histopathological findings. The study was compared with other relevant studies. The data was analysed using Microsoft Excel 2019 software.
Results: A total of 164 cases of SCD were included in this study. The maximum number of deaths occurred in the age group of 51-60 years (42 cases). The male to female ratio was 2.6:1, indicating an overall male preponderance. Out of 164 autopsied hearts, 85 cases of Ischemic Heart Disease (IHD), including new, old, and mixed lesions were found, followed by Hypertrophic Cardiomyopathy (HCM) in 25 cases, multiple lesions in 12 cases, dilated cardiomyopathy in four cases, tubercular pericarditis with myocarditis in one case, infective endocarditis in three cases, atherosclerosis in one case, coronary insufficiency in one case, cardiac myxoma in one case.
Conclusion: Many factors can lead to SCD in apparently healthy individuals or in people with cardiac disease. In the present study, the most common cause contributing to SCD was IHD. The cause of SCD can be identified by a thorough post-mortem examination and histological analysis.
INTRODUCTION : Cardiovascular disease (including coronary artery disease, stroke and peripheral vascular disease) is no.1 cause of worldwide mortality, with about 80% of burden occurring in developing countries. Sudden cardiac death is dened as unexpected death from cardiac causes either without symptoms or within 1-24 hours of onset of symptoms(1). The common cause of sudden cardiac death is ischaemic heart disease. Non ischaemic sudden cardiac death occurs in hypertrophic obstructive cardiomyopathy and in severe left ventricular hypertrophy(2). The purpose of this study will be to determine the causes of sudden death and observe the spectrum of morphological and histopathological changes in heart after sudden death. MATERIALS AND METHODS: This autopsy study was conducted on 121 cases of sudden death over a period extending from January 2019 to August 2020 in autopsy section of Pathology department of BJGMC, Pune. In this autopsy study hearts of patients with a history of sudden death were evaluated for histological and morphological changes. Each heart was grossed adopting the inow outow method and short axis method. Staining solutions used were Solution A: Alum Hematoxylin and Solution B: 1% Eosin Y. OBSERVATIONS : 50 (41.32%) cases out of 121 cases had coronary artery disease along with myocardial infarction of which 43 cases were males and 7 cases were females. No cardiac aetiology was found in 23.96% cases. Coronary artery disease was independently seen in 14.87% cases. Left ventricular concentric hypertrophy was noted in 4.13% cases. Myocardial infarction independently was noted in 3.30%cases, Myocarditis in 2.47% cases, myocarditis with pericarditis in 1.65% cases, HOCM, lipoma, mitral stenosis, pericarditis, septic infarct, secondaries of adenocarcinoma, early vegetation and small vessel disease in 0.82% cases. Calcic aortic stenosis was demonstrated in 1 case. Brown atrophy was demonstrated in 1 case. DISCUSSION : Out of 69 cases of coronary artery disease calcication was commonly seen in 34(49.27%) cases. 47(82.45%) (M-39,l F-8) out of 57 cases of myocardial infarction demonstrated chronic or old infarct. Single vessel involvement was most common in which left anterior descending coronary artery was signicantly involved in 68.75 % cases. Posterior wall was most commonly involved by myocardial infarction which included posterior, posteroseptal, and posterolateral infarcts.
Kematian mendadak adalah kematian natural dalam
24 jam dari munculnya gejala (WHO, ICD-10 2016).
Pada kematian mendadak, penyebab tercepat
hampir selalu ditemukan pada sistem
kardiovaskular. Walaupun jarang, diseksi aorta
torakalis adalah penyakit mematikan yang paling
umum yang mengenai aorta dan paling umum dari
pada ruptur aneurisma aorta abdominalis.Angka
kejadian diseksi aorta diperkirakan 5-30 per juta
orang per tahun. Studi berdasarkan populasi telah
memperkirakan angka kejadian diseksi aorta akut
sekitar 3 kasus per 100.000 orang per tahun. Angka
prevalensi diseksi aorta setelah otopsi adalah 1 - 3
%. Diseksi aorta yang tidak diterapi memiliki angka
mortalitas 25-33 % dalam 24 jam, 50 % dalam 48
jam, 75-80 % dalam 2 minggu, dan menjadi 90 %
setelah 3 bulan tanpa terapi yang tepat.
Jenazah adalah seorang laki-laki berkebangsaan
Jepang berusia sekitar 63 tahun, panjang badan 173
cm dan berat badan 88 kg.Pada pemeriksaan luar
tidak ditemukan luka-luka pada jenazah dan
ditemukan tanda-tanda perbendungan. Pada
pemeriksaan dalam ditemukan darah dan bekuan
darah di dalam kandung jantung, robekan pada
dinding aorta, dan lapisan tunika intima aorta yang
terpisah dari tunika media dan adventisia mulai dari
arkus aorta hingga aorta abdominalis, aterosklerosis
pada dinding dalam aorta serta tanda-tanda
perbendungan pada organ-organ dalam. Hasil
pemeriksaan histopatologi menunjukkan ruptur
miokard, sebukan eritrosit dan sebukan PMN pada
sediaan jantung,proliferasi tunika media,
pembentukan false lumen antara tunika intima dan
tunika media pada sediaan arteri koroner serta
pembentukan false lumen antara tunika media dan
tunika adventisia disertai sebukan eritrosit pada
sediaan dinding aorta.
Introduction- Formalin poisoning, mostly accidental, if not suicidal, is relatively common in those areas where the chemical is used or easily available like textile factory, rubber factory,printing etc. Strong irritation and offensive, pungent odour contributes to its rarity.
Case history- A 68 year old male was admitted with history of formalin poisoning 7hrs 35mins back. He was referred from local hospital after initial management. On admission patient had hypotension, tachycardia. He expired 40mins after admission. Medicolegal autopsy revealed congested conjunctiva. On dissection, congestion and petechial haemorrhages were present in the internal organs. Peritoneal cavity contained small amount of straw coloured fluid. Mucous membrane of stomach had multiple submucosal petechial haemorrhages and denudation with whitish streaks of blunt rugae and oedematous lamina propria. Intestinal mucosa was shrunken,grossly thinned out like paper with extravasations of blood. Liver showed feature of steatosis with micro and macrovesicular droplets and subcapsular haemorrhages. Both kidneys were congested with scattered haemorrhages on surface at places including corticomedullary junctional multiple haemorrhagic spots with features of acute tubular necrosis.
Discussions- Formalin poisoning affects all the systems as it is easily absorbed through respiratory and gastrointestinal tract and spreads in whole body through blood causing constriction in chest, palpitation, pain abdomen and gastrointestinal irritation, urinary abnormality, liver damage and clotting factors abnormality. This type of poisoning is rare and unusual. It’s associated with high mortality rate, so proper elicitation of history, identification of the offending material and postmortem histopathology are essential.
Conclusions- The present investigation is an attempt to highlight the clinical picture along with autopsy histopathology in details of formalin poisoning. Such studies are essential in developing appropriate preventive strategies.
Keywords: Formalin poisoning, Submucosal petechial haemorrhages, Acute tubular necrosis, Steatosis, Autopsy histopathology.
Forensic Histopathology & Toxicology
Three hundred and fifty cases of "natural" sudden death within six hours of onset of symptoms in people ranging in age from 18 to 69 years in Wandsworth were studied using a detailed necropsy protocol to determine the cause of death. Sudden death occurred in 28 (8%) Asians and blacks, but because of the small number they were excluded from the study, leaving 322 cases. Ischaemic heart disease accounted for 189 (59%) of the 322 sudden deaths (155 (65%) men; 34 (41%) women) and no proportional increase in instantaneous compared with non-instantaneous sudden death was found. Non-ischaemic cardiac disease was the cause of sudden death in 24 cases (7.5%). Non-cardiac disease included pulmonary emboli, aortic aneurysms, and intracerebral haemorrhage and caused 89 (27.6%) deaths. Alcohol was the cause of nine deaths (2.8%) and in 11 (3.4%) cases (six men and five women) no cause of death was found. This study shows that although ischaemic heart disease is the single largest cause of sudden natural death there are other major causes.
For more than 20 years in Italy, young athletes have been screened before participating in competitive sports. We assessed whether this strategy results in the prevention of sudden death from hypertrophic cardiomyopathy, a common cardiovascular cause of death in young athletes.
We prospectively studied sudden deaths among athletes and nonathletes (35 years of age or less) in the Veneto region of Italy from 1979 to 1996. The causes of sudden death in both populations were compared, and the pathological findings in the athletes were related to their clinical histories and electrocardiograms. Cardiovascular reasons for disqualification from participation in sports were investigated and follow-up was performed in a consecutive series of 33,735 young athletes who underwent preparticipation screening in Padua during the same period.
Of 269 sudden deaths in young people, 49 occurred in competitive athletes (44 male and 5 female athletes; mean age, 23+/-7 years). The most common causes of sudden death in athletes were arrhythmogenic right ventricular cardiomyopathy (22.4 percent), coronary atherosclerosis (18.4 percent), and anomalous origin of a coronary artery (12.2 percent). Hypertrophic cardiomyopathy caused only 1 sudden death among the athletes (2.0 percent) but caused 16 sudden deaths in the nonathletes (7.3 percent). Hypertrophic cardiomyopathy was detected in 22 athletes (0.07 percent) at preparticipation screening and accounted for 3.5 percent of the cardiovascular reasons for disqualification. None of the disqualified athletes with hypertrophic cardiomyopathy died during a mean follow-up period of 8.2+/-5 years.
The results show that hypertrophic cardiomyopathy was an uncommon cause of death in these young competitive athletes and suggest that the identification and disqualification of affected athletes at screening before participation in competitive sports may have prevented sudden death.
The purpose of this report is to describe the main autopsy and laboratory findings from a large number of drowning victims in Greece.
A retrospective analysis was carried out of the consecutive cases of drowning victims autopsied in our department during the period 1997-2004.
A total of 197 submersion cases were referred to the Department. In 168 cases drowning was considered as the cause of death. In 82 cases (49%) significant histopathological findings from the cardiovascular system were present. Alcohol was found in 21 cases (13%) and psychoactive substances in 4 cases (2%). Food was found in the stomach of 45 drowning victims (27%). Men (65%) and elderly people (60 years and older, 74%) made up the majority of drowning victims. In 29 submersion cases the cause of death was other than drowning; in 25 of these cases death was attributed to cardiovascular disease (complication of coronary artery disease, 23 cases; dissecting aortic aneurysm, 1 case; cerebral stroke, 1 case).
The great majority of drowning victims are the elderly and men. Moreover, in a considerable number of submersion cases cardiovascular disease was related to the death, either as a contributing factor, or as the cause of death.
To investigate the pathological features and causes of sudden death clustered in family or village in Yunnan province so as to provide the morphological basis for exploring its etiology and medical intervention.
Autopsy was performed on 29 cases of clustered in family or village in Yunnan province during the period 1991-2006, 16 males and 13 females, aged 32 (8-69), accounting for 10.2% of whole sudden unexpected deaths occurring in the same period. The heart, lung, liver, spleen, brain, kidney, intestinal tract, and other organs were examined macroscopically and histologically, including a study of cardiac conduction system in 5 cases. Pathological diagnosis of myocarditis was based on the Dallas Criteria and World Heart Federation's consensus while the histological evaluation of Keshan disease referred the China national guideline for pathological diagnosis of Keshan disease.
Based on the main pathological changes and the causes of death, these cases were classified into seven groups (group A-G). Group A comprised 11 cases (38%) with lymphocytic myocarditis accompanied with focal myocardial necrosis or degeneration. Group B comprised 3 cases (10%) with neutrophil myocarditis accompanied with focal myocytolysis or coagulation necrosis. Group C comprised 4 cases (14%) with arrhythmogenic right ventricle cardiomyopathy in which fatty infiltration of myocardium was the only pathological finding. Group D comprised 2 cases (7%) with ischemic heart disease in which fresh or old foci of myocardial infarction were found but coronary stenosis was shown only in one case. Group E comprised 2 cases (7%) with left ventricle hypertrophy and obstructive muscle bundle in the outflow of left ventricle. Group F comprised 2 cases (7%) with allergic bronchitis or chronic bronchitis and pulmonary emphysema. Group G comprised the remaining 5 cases (17%) without any pathological finding that could explain sudden death. No cases suffered with Keshan disease and dilated cardiomyopathy. Focal but not diffuse inflammatory infiltration was the prominent histological feature of myocarditis in Yunnan cases. Among the five cases with histological examination of cardiac conduction system, 2 cases were detected to suffer from acute hemorrhage in His bundle and its left branching site, and the atrioventricular node of 1 case was involved. Different pathological changes coexisted in 4 pairs of family members as a cluster of sudden deaths. 3 of 4 first deaths had focal myocarditis and the other one had chronic infection. But 3 secondary deaths had myocardial ischemia and the other one had arrhythmogenic right ventricle cardiomyopathy. Pulmonary edema, acute respiratory infection and congestive or ischemic liver necrosis were found in some cases simultaneously.
The pathological changes of the cases of clustered sudden death in Yunnan province are various, such as myocarditis, myocardial dysplasia and the other lethal heart-lung disorders. No case of Keshan disease has been found. Arrhythmogenic right ventricle cardiomyopathy and other foundational heart diseases might act as a background. It is very hard to contribute only one etiological factor to the clustering of sudden death in Yunnan. It was most likely that multiple factors cluster and trigger an outbreak of death in a definite time and space.
Sudden cardiac death (SCD) is a very common mechanism for cardiac mortality in all developed nations, yet means to identify individuals at increased risk for this condition and effective strategies for its prevention remain elusive. For many years the focus of SCD research has concentrated on averting those conditions that are its primary antecedents, such as athero-thrombotic coronary artery disease, hypertension and heart failure. Recently however, major advances have occurred in understanding those more immediate cellular and molecular influences that contribute to the overall prevalence of SCD and the mechanisms responsible for its initiation in both apparently healthy individuals and those with established cardiac diseases. This “Spotlight” issue of the Journal has been designed to highlight many of these new discoveries and the remarkable progress and challenges that characterize this field today.
A number of factors have contributed to the difficulties that characterize the historically slow pace of progress in SCD research. Rather than being associated with specific, identifiable symptoms, the pathophysiology of SCD, in most cases, is diffuse in presentation, unpredictable in time, and its major cause, initiation of lethal ventricular arrhythmias, appears highly varied in different individuals. As suggested by the most commonly used definition of SCD, “…any near instantaneous, electrically-based, cessation of cardiac output in individuals with otherwise uncompromised circulatory function,” the forms of cardiac disease from which it arises are broad, and include a full spectrum of conditions from structural malformations, to progressive acquired pathologies, as well as terminal manifestations of otherwise silent genetic susceptibilities that may express at any life stage. Recent discoveries concerning several of these latter conditions (e.g. the Long QT Syndromes) have, however, over the past five years, catapulted SCD research to the forefront of investigations on the molecular causes of cardiovascular disease; and continuing population and laboratory discoveries on the heritable …
* Corresponding author. Tel.: +1-301-435-0507; fax: +1-301-480-1454
The aim of the present study was to analyze the concordance between clinical and autopsy diagnoses. For this purpose, 100 patients submitted to autopsy from July 2000 to April 2001 were studied prospectively. In all cases, clinicians gave the immediate and the underlying causes of death for patients dying under their care. The diagnoses were compared to the macroscopic autopsy diagnoses. Cohen's kappa coefficient of agreement was estimated. Sixty-four men and 36 women were submitted to autopsy. The most frequent pathological diagnosis of underlying cause of death were diseases of the circulatory system (35%), infections and parasitic diseases (20%) and diseases of the digestive system (11%). The kappa coefficient for immediate cause of death was 0.40 (95% confidence interval (CI): 0.29-0.50); for underlying cause it was 0.38 (95%CI: 0.18-0.44), and for basic cause codified by group according to ICD-10 it was 0.55 (95%CI: 0.44-0.67). Major disagreement occurred in 10 cases involving pathological causes of death as circulatory diseases, in which the clinicians diagnosed a digestive system disease as the cause of death (n = 5), or infectious and parasitic diseases (n = 5). The present study shows that agreement between clinical and pathological causes of death are moderate, proving that the autopsy is still a very important procedure.
This study retrospectively assesses the underlying causes of sudden unexpected death and the occurrence of prodromal symptoms in 162 subjects (aged 9 to 39 years) over a 10-year period (1976 to 1985). Underlying cardiac diseases accounted for sudden death in 73% and noncardiac causes in 15% of subjects. In 12% of subjects, the causes were unidentifiable. Myocarditis (22%), hypertrophic cardiomyopathy (22%) and conduction system abnormalities (13%) were the major causes in 32 subjects aged less than 20 years. Major causes of 46 deaths in subjects 20 to 29 years were atherosclerotic coronary artery disease (24%), myocarditis (22%) and hypertrophic cardiomyopathy (13%). The largest number of deaths in 84 subjects aged greater than or equal to 30 years was attributed to coronary artery disease (58%), followed by myocarditis (11%). Among noncardiac causes of sudden death, intracranial hemorrhage was the most frequent (5%), followed by infectious disease (4%). Prodromal symptoms were reported by 54% of subjects; most frequent were chest pain (25%) in subjects aged greater than or equal to 20 years, and dizziness (16%) in those aged less than 20. Sudden death, which occurred during routine daily activity in 49% and during sleep in 23% of subjects, was related to physical exercise in 23% and emotional upset in 6%. Sudden unexpected death in the young is still an unresolved medical problem. The early recognition of prodromal symptoms could be crucial in the prevention of sudden death, specifically when exercise-related.
During the years 1974-86 in the Israel Defense Force (IDF), 83 soldiers aged 17-39 years died suddenly and unexpectedly. Cardiac causes accounted for 56% of the deaths, neurological causes for 19%, other diseases for 8% and in 17% the cause of death was unknown. Causes of death varied between soldiers younger and those older than 30 years of age. Ischemic heart disease accounted for 58% of deaths in soldiers greater than 30 years old but was an infrequent cause of death in subjects less than 30 years (4%). Congenital cardiac anomalies (27%) and myocarditis (15%) accounted for most deaths in subjects less than 30 years of age. Epilepsy was a common cause of sudden death (10%), occurring mainly during sleep, and was related to poor medical control. Effort-related deaths occurred in 25 cases (30%) and were mainly associated with cardiac causes. Syncope (18%) and chest pain (18%) were common symptoms prior to death. According to our data and previous reports, sudden death continues to be an unresolved medical problem in young adults. Preventive measures should include a more thorough evaluation of symptoms such as syncope and chest pain, particularly when occurring during or after exercise. Furthermore, early coronary artery disease should not be disregarded in subjects as young as 30 years of age.
This study outlines the role of autopsies in medical practice and health policy, details the nature and reason for declining rates, including those in Rochester, Minnesota, and suggests possible remedial measures to halt or reverse this trend. It is concluded that one of the principal impediments to reversing the declining rate of autopsies is what is referred to in Economics as "market failure." In particular, the nature of the spatial and temporal distribution of costs and benefits has precluded the existence of an incentive structure which can lead to a realization of the major net social benefits from the autopsy. Ultimately, it is only the explicit recognition by the medical profession, government agencies, corporate insurers, and the general public of the nature and significance of this market failure and foregone benefits which can lead to remediation.
To determine the number of unsuspected disease processes found in a series of cases of sudden unexpected death occurring outside hospital and to enumerate how many of these were not recorded on the death certificate.
In a series of 1000 routine coroners' necropsies for sudden unexpected death, major findings that had not been known about in life were recorded. Macroscopic findings were confirmed histologically as appropriate. The deaths occurred either outside hospital or in the Accident and Emergency department before the patient could be examined. Cot deaths and decomposed bodies were excluded.
There were 575 major findings in 532 (53.2%) subjects that had been clinically silent in life. Of these 575 findings, 277 (48.2%) were not the cause of death and so did not appear on the death certificate. Eighty per cent of the major alimentary system findings and all of the genitourinary findings were of this type. In addition, however, 30% of the major cardiovascular and 34% of the major respiratory findings were not recorded on the death certificate for this reason.
A large amount of important epidemiological data is being lost in the operation of the coronial system. Some of this information is irrecoverable as the function of the death certificate is to provide a cause of death only. In addition, information may be being lost because the necropsy is not being performed adequately and is not subject to audit.
Autopsy rates have not been reported at the University Hospital of the West Indies (UHWI) for more than three decades. Declining rates have been documented worldwide, and so we sought to define autopsy rates over the past three decades at UHWI. We conducted a retrospective analysis of the numbers and types of autopsies performed on deaths occurring in the institution, and calculated the relevant autopsy rates. The overall autopsy rate for the study period was 52.7%, with a statistically significant decline from 65.3% in the first decade to 39.3% in the third. The non-coroner's autopsy rate showed a concomitant decline from 57.5% to 31.5%, while the coroner's autopsy rate remained stable with a slight increase from 28.1% to 29.1%. The factors that might have led to the decline of the autopsy are discussed.
Time for primary review 29 days.
When sudden death (SD) occurs in adults and elderly persons, coronary atherosclerosis is the usual cause [1,2]. On the contrary, a large spectrum of cardiovascular diseases, both congenital and acquired, may account for SD in the young [3–10]. These diseases are frequently concealed and discovered with surprise only at postmortem by means of a thorough macroscopic and microscopic investigation. This review will address the spectrum of structural substrates of cardiac SD with particular emphasis given to the possible role of molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability.
SD is defined as a natural, unexpected fatal event occurring within 1 h of the beginning of symptoms, in an apparently healthy subject or one whose disease was not so severe enough as to predict such an abrupt outcome [11]. In the USA, the annual incidence of SD in people aged 35–74 years is 191/100 000 in men and 57/100 000 in women; almost half of all SDs occur in people with known coronary artery disease [12]. In the Veneto region, Northeast of Italy, we recently calculated an overall prevalence of SD of 0.8/100 000/year in the young, based only upon autopsy reports [13]. When focusing the attention only on young athletes the prevalence was twice that in young non athletes, i.e. 1.6/100 000/year; these figures are explained by the existence of cardiovascular diseases which cause a risk of SD during effort, such as hypertrophic cardiomyopathy (HCM), arrhythmogenic right ventricular cardiomyopathy (ARVC) and congenital coronary anomalies.
As far as pathophysiology is concerned, cardiac arrest may be either mechanical, when the heart and circulatory functions are suddenly impeded by mechanical factors (i.e. cardiac tamponade, pulmonary thromboembolism, etc.) or arrhythmic (mostly ventricular fibrillation) [9].
Based …
* Corresponding author. Tel.: +39-49-827-2283; fax: +39-49-827-2284 cardpath{at}ux1.unipd.it
Among all the autopsies performed between 1995 and 2000 in our Department, 77 adult cases of sudden death were selected. Sex, age, place of death, circumstances of death, causes of death and heart weight were reported from these 77 post-mortem records. A complete forensic autopsy was performed in every case.
Sudden death occurred more frequently in males at rest. Strenuous activity was rarely involved in sudden death and 72.7% of the cases died from cardiovascular disease, mainly coronary atherosclerosis. Non-cardiac causes were dominated by pulmonary and neurological diseases. Cardiomegaly was a frequent finding in cases who died from cardiac pathology.
This study underlines the importance of complete medico-legal investigations in case of sudden death. Multiple heart samples are required in order to detect focal microscopic lesions, such as myocarditis and some forms of cardiomyopathy with minimal gross abnormalities. The post-mortem diagnosis of such cardiomyopathies is very important because the family of the deceased may undergo a possible screening. Toxicology is useful in the diagnosis of epileptic seizure and in identifying drugs like metamphetamine as a risk factor for some lethal cardiovascular pathologies such as aortic dissection. Molecular biology can also be helpful when limits of morphological diagnosis have been reached.
Medicolegal (coroner's) autopsies are an important source of epidemiological data. A large proportion of them comprise sudden natural deaths and an analysis of such cases has never been undertaken at the University Hospital of the West Indies, the only teaching hospital in Jamaica. In a retrospective study, 841 cases of sudden natural deaths comprising 51.3% of the medicolegal autopsies conducted over the 15-year period, January 1983 to December 1997, were analyzed. There were 459 males and 382 females (M:F ratio = 1.2:1); 35 patients (4.1%) were less than 1 year of age, and the mean age of the remainder was 53.7+/-21.8 years. The peak age group was the seventh decade accounting for 21.9% of cases. The most common causes of death were cerebrovascular accidents (13.6%), pneumonia (9.4%), pulmonary embolism (7.4%), ischaemic heart disease (7.0%) and diabetes mellitus (6.1%). These findings contrasted with those from developed countries in which ischaemic heart disease is the commonest cause of sudden death. Hypertension was associated with the majority of cases of cerebrovascular accident and congestive cardiac failure (78.1 and 61.9%, respectively). Sickle cell disease represented one of the 10 most common causes of death accounting for 2.5% of cases. Documentation of autopsy-based data such as these is important in the planning of medical services in a developing country.
A simplified method of the His bundle analysis is evaluated by the study of 110 forensic cases. The atrioventricular node or its part were observed in 96 cases (87.3%), penetrating bundle in 92 cases (83.6%), branching and left bundles branch in 109 cases (99.1%) and right bundle branch in 73 cases (66.4%). The changes such as fibrosis and fatty infiltration show statistically significant differences (P<0.01) between progressive age groups confirming their degenerative and age-related nature. The study included as well nine cases of sudden unexpected death and two cases of sudden infant death syndrome (SIDS), for which the autopsy with histological examination and toxicological analysis resulted negative. For nine of these cases, pathological lesions were found which can even explain the fatal issue. Moreover, in the cases with known cause of death, potentially lethal changes were noticed. This simple, low cost technique could be proposed to forensic pathologists as easy to fit into the routine processing of autopsy material, allowing the detection of major abnormalities with minimal effort. The authors also consider the difficulties related to the interpretation of the pathological findings in the conduction system.
Sudden death is a possible consequence of arrhythmogenic right ventricular cardiomyopathy/dysplasia (ARVC/D). Prevalence of ARVC/D in unexpected sudden cardiac death (USCD), however, remains imprecise, as do circumstances of death and ARVC/D-associated gross and microscopic findings, especially His bundle anomalies.
We reviewed 14 000 forensic autopsies required by judicial authorities from January 1980 to January 1999 in a 2 000 000-resident area. Age, gender, and circumstances of death were recorded. Hearts were examined macroscopically and microscopically. In this series, the ARVC/D group accounted for 200 consecutive cases (10.4%) of USCD, including 108 males and 92 females (average age 32.5 and 34.5 years, respectively). Nearly one third of deaths occurred during the fourth decade of life. Circumstances of death were various, but 75.6% occurred during everyday life events (at home, 63.1%; in the street, 6.6%; or at work, 6.1%); only 7 cases (3.5%) occurred during sports activity. Nineteen cases (9.5%) happened during the perioperative period. Adipose infiltration of the right ventricle was either isolated (20%) or associated with fibrosis (74.5%) and lymphocytes (5.5%). A total of 14.5% of cases had cardiac hypertrophy, assessed by an increase in heart weight and/or left ventricular wall thickness. In most cases, the His bundle and its branches were abnormal either because of infiltration of adipose tissue (8.1%), fibrosis (54.3%), or both (5.6%).
In ARVC/D, both sexes are equally affected, and there is a peak of risk during the fourth decade. Death most frequently occurs during sedentary activity. His abnormalities and left ventricular hypertrophy may be associated with ARVC/D.
The autopsy is in decline, despite the fact that accurate mortality statistics remain essential for public health and health service planning. The falling autopsy rate combined with the Coroners Review and Human Tissue Act have contributed to this decline, and to a falling use of autopsy histology, with potential impact on clinical audit and mortality statistics. At a time when the need for reform and improvement in the death certification process is so prominent, we felt it important to assess the value of the autopsy and autopsy histology. We carried out a meta-analysis of discrepancies between clinical and autopsy diagnoses and the contribution of autopsy histology. There has been little improvement in the overall rate of discrepancies between the 1960s and the present. At least a third of death certificates are likely to be incorrect and 50% of autopsies produce findings unsuspected before death. In addition, the cases which give rise to discrepancies cannot be identified prior to autopsy. Over 20% of clinically unexpected autopsy findings, including 5% of major findings, can be correctly diagnosed only by histological examination. Although the autopsy and particularly autopsy histology are being undermined, they are still the most accurate method of determining the cause of death and auditing accuracy of clinical diagnosis, diagnostic tests and death certification.
Multiple organ pathologies underlying in sudden natural deaths
- Bora Ozdemir
- Osman Celbis
- Rezzan Onal
Bora Ozdemir, Osman Celbis, Rezzan Onal, et al.
Multiple organ pathologies underlying in sudden
natural deaths. Medicine Science 2012;1(1):13-26.
Evaluation of cardiac conduction system in sudden death cases
- Ramazan Karanfil
- K Mete
- Ahmet Gulmen
- Hilal
Ramazan Karanfil, Mete K Gulmen, Ahmet Hilal, et al.
Evaluation of cardiac conduction system in sudden
death cases. J For Me 2013;27(1):17-28. doi:
10.5505/additip 2013. 54154.
Examination of the cardiovascular system, in Forensic investigation of sudden deaths from the cardiovascular system
- C Spiliopoulou
Spiliopoulou C. Examination of the cardiovascular
system, in Forensic investigation of sudden deaths
from the cardiovascular system. Parisianou editions.
Athens 2004;8-25. (Greek).
Fausto and Aster Robbin's pathological basis of disease
- Vinay Ramzi S Cortan
- Kumar
Ramzi S Cortan, Vinay kumar. Fausto and Aster
Robbin's pathological basis of disease. USA: Elsevier,
PA. 2010;8 th edition:529-87.
Causes of death in sickle cell disease: an autopsy study
- A Elizabeth
- Donald E Manci
- Yih-Ming Culberson
- Yang
Elizabeth A Manci, Donald E Culberson, Yih-Ming Yang,
et al. Causes of death in sickle cell disease: an autopsy
study. British Journal of Haematology 2003;123:359-365.
Robbins basic pathology Indian Reprint
- Abbas Kumar
- Fausto
Kumar, Abbas, Fausto, et al. Robbins basic pathology.
Indian Reprint; 8 th edition: ISBN: 978-81-312-1036-9
Forensic examination of the dead
- A Koutselinis
Koutselinis A. Forensic examination of the dead, in
Forensic Medicine. Parisianou Editions, Athens
2001;55-71. (Greek).
Forensic medicine. London: Hodder Arnold Publication
- K Simpson
- B Knight
Simpson K, Knight B. Forensic medicine. London:
Hodder Arnold Publication; 1997;11 th ed.
Adli otopsi (in Turkish). Istanbul: Istanbul Universiti Cerrahpasa Tip Fakultesi Yayinlari
- Z Soysal
- S M Eke
- A S Cagdir
Soysal Z, Eke SM, Cagdir AS. Adli otopsi (in Turkish).
Istanbul: Istanbul Universiti Cerrahpasa Tip Fakultesi
Yayinlari; 1999.
Clinical and pathological disagreement upon the cause of death in a teaching hospital: analysis of 100 cases in a prospective study
- Pinto Carvalho
- F L Cordeiro
- J A Cury
Pinto Carvalho FL, Cordeiro JA, Cury PM. Clinical and
pathological disagreement upon the cause of death in
a teaching hospital: analysis of 100 cases in a
prospective study. Pathol Int 2008;58(9):568-71.