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Histopathological array of cardiac lesions: An autopsy based study in a tertiary care centre
Abstract
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.
... Similarly, in a study, it was found that maximum number of cases presented in the age group of 41-50 years. [12] Cardiomegaly accounts for 25% of all the cases. ...
... [14] Verma R et al. in their study found that out of the three coronary arteries, left anterior descending was most commonly involved vessel, followed by left circumflex artery and right coronary artery. [12] Radu I et al. conducted a study and found that atherosclerosis constituted majority of cases with SCD and comprised of 89.8% of cases. [15] In contrast to this, Khan MRM et al. found that myocardial infarction was the major contributory cause of SCD in 44% of patients. ...
A BSTRACT
Introduction
Sudden cardiac death (SCD) is defined as an abrupt and unexpected death caused by cardiovascular disease, regardless of whether the individual has a history of heart disease. The conditions included in this classification are myocardial infarction (MI), coronary atherosclerosis, myocardial hypertrophy, myocarditis, aortic valve dysfunction, and ruptured aortic aneurysm. The objective of this study was to analyze and examine different cardiac illnesses and histopathological abnormalities of the heart that occur in SCDs, based on a 4-year autopsy experience in Jharkhand.
Methods
A retrospective observational study spanning 4 years was undertaken on autopsy specimens of whole hearts submitted for histological analysis in the Department of Pathology, RIMS, from April 2020 to March 2024. We evaluated several histological alterations in the heart of all the received autopsy specimens.
Results
A wide variety of histological abnormalities has been observed, with atherosclerosis being the most prevalent. Additional pathological conditions observed were myocardial infarction (MI), hypertrophy, cardiomyopathy, metastasis, myocarditis, pericarditis, and tuberculosis of the heart.
Conclusion
Atherosclerosis is the primary etiology of SCD and predominantly affects middle-aged adult males in the Jharkhand population. Comprehending the histopathological results is crucial for identifying the cause of death, adhering to the minimum autopsy requirements for SCD, and enhancing treatment and preventive efforts to decrease SCD mortality.
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
Background
There has been a notable rise in cardiac-related fatalities globally, especially in the last five decades. In India, ischemic heart disease has become prevalent, affecting roughly 10% of the population. For forensic specialists, establishing the cause of death in individuals previously in good health can be complex. Autopsies are crucial in evaluating the underlying factors responsible for such deaths. This research seeks to identify and scrutinize a wide range of histopathological heart abnormalities that significantly influence the determination of the cause of death.
Materials and Methods
This study was conducted in the Department of Pathology from January 2020 to December 2020. During this period, we received a total of 209 whole heart specimens. Of these, 208 specimens underwent comprehensive examinations, including macroscopic and microscopic observations.
Results
Out of the 208 cases examined, 94 showed evidence of both early and advanced atherosclerosis, whereas 65 showed early and late signs of myocardial infarction. Myocardial hypertrophy was evident in 29 patients. Isolated instances of myocarditis and pericarditis were observed in one case each. Fatty streaks were identified in 32 cases; three showed red blood cells with sickle cell morphology. Heart rupture was detected in one case, and another revealed metastasis from a poorly differentiated tumor. Notably, in 90 cases, the cause of death remained undetermined despite thorough macroscopic and microscopic autopsies.
Conclusion
The primary reason for cardiovascular fatalities is atherosclerosis-related myocardial infarction.
Introduction: Atherosclerosis accounts for a large proportion of cardiovascular system associated morbidity and mortality. Coronary artery disease (CAD) is the leading cause of global deaths with about 80% of burden occurring in developing countries. Material & Methods: In order to assess the magnitude of the problem, a retrospective study of autopsy cases for the presence of atherosclerotic lesions of coronary arteries and associated ischemic cardiac lesionswas under taken from January 2013 to December 2017. Also, correlation of the atherosclerosis with ischemic heart diseases was studied. Result: Total number of heart specimens received in department of Pathology during four years were 272. Out of these 57 were autolyzed and were excluded from the study. Significant atherosclerotic lesions were seen in 54(25.11%) and 64(29.76%) cases in right and left coronary arteries respectively and were statistically significantly higher among age group > 41 years as compared to those with age <41 years, overall atherosclerotic lesions were significantly higher in age groups >41 years as compared to <41 years. Conclusion: Maximum number of significant cardiac lesion were associated with atherosclerotic type VIII lesions (75%) followed by type VII (66.66%) and type VI (33.33%). Maximum number of significant myocardial lesions were associated with grade IV (66.66%) coronary luminal narrowing followed by grade III (45.71) and grade II (38.46). The study also showed significant correlation between the higher grade of the coronary atherosclerotic lesions and the ischemic heart disease.
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.
Although sudden cardiac death (SCD) is one of the most important modes of death in Western countries, pathologists and public health physicians have not given this problem the attention it deserves. New methods of preventing potentially fatal arrhythmias have been developed and the accurate diagnosis of the causes of SCD is now of particular importance. Pathologists are responsible for determining the precise cause and mechanism of sudden death but there is still considerable variation in the way in which they approach this increasingly complex task. The Association for European Cardiovascular Pathology has developed these guidelines, which represent the minimum standard that is required in the routine autopsy practice for the adequate investigation of SCD. The present version is an update of our original article, published 10 years ago. This is necessary because of our increased understanding of the genetics of cardiovascular diseases, the availability of new diagnostic methods, and the experience we have gained from the routine use of the original guidelines. The updated guidelines include a detailed protocol for the examination of the heart and recommendations for the selection of histological blocks and appropriate material for toxicology, microbiology, biochemistry, and molecular investigation. Our recommendations apply to university medical centers, regionals hospitals, and all healthcare professionals practicing pathology and forensic medicine. We believe that their adoption throughout Europe will improve the standards of autopsy practice, allow meaningful comparisons between different communities and regions, and permit the identification of emerging patterns of diseases causing SCD. Finally, we recommend the development of regional multidisciplinary networks of cardiologists, geneticists, and pathologists. Their role will be to facilitate the identification of index cases with a genetic basis, to screen appropriate family members, and ensure that appropriate preventive strategies are implemented.
Introduction:
Incidence of sudden cardiac death (SCD) has been steadily increasing all over the world. While knowing the cause of SCD is one of the favorites of the physicians involved with these cases, it is very difficult and challenging task for the forensic physician. The present report is a prospective study regarding cause of SCDs on autopsy examination in four-year period, Bangalore, India.
Methods:
The present prospective study is based on autopsy observations, carried out for four-year period from 2008 to 2011, and analyzed for cause of SCDs. The cases were chosen as per the definition of sudden death and autopsied. The material was divided into natural and unnatural groups. Finally, on histopathology, gross examination, hospital details, circumstantial, and police reports the cause of death was inferred.
Results:
A total of 2449 autopsy was conducted of which 204 cases were due to SCD. The highest SCDs were reported in 50-60 years age group (62.24%; n-127), followed closely by the age group 60-69 (28.43%; n-58). Male to female ratio was around 10:1. The maximum number of deaths (n=78) was within few hours (6 hours) after the onset of signs and symptoms. In 24 (11.8%) cases major narrowing was noted in both the main coronaries, in 87 (42.6%) cases in the left anterior descending coronary artery (LAD), and in 18 (51.5%) cases in the right coronary artery (RCA). The major cardiac pathology resulting in sudden death was coronary artery disease (n-116; 56.86%) and myocardial infarction (n-104; 50.9%). most of the SCDs occurred in the place of residence (n-80; 39.2%) followed closely by death in hospital (n-49; 24.01%).
Conclusion:
Coronary occlusion was the major contributory cause of sudden death with cardiac origin and the highest number of deaths were reported in the age 50-59 years with male to female ratio of 10:1.
The incidence of coronary heart disease has markedly increased in India over the past few years. Ischemic heart disease, the largest cause of morbidity and mortality in the developed and developing countries today is overwhelmingly contributed by atherosclerosis. The study highlights the impact of atherosclerotic lesions in the population of Haryana. We studied atherosclerotic lesions in coronaries in cases subjected to autopsy, to grade and to evaluate the atheromatous plaques; and to assess the cases of myocardial infarction amongst them. The study comprises dissected specimens of heart in 115 cases subjected to autopsy. The vessels were examined for the presence of atherosclerotic lesions which were graded according to American Heart Association and examined for evidence of myocardial infarction. The study comprises the cases in age group of 15 to 85 years. 46.4% showed significant atheroma. Commonest type of atherosclerosis seen was grade-3. Triple vessel involvement was seen in 44.4% cases. Left Anterior Descending was most commonly involved artery. Myocardial infarction was the cause of death in in 3 cases (3%) while 23 showed changes of chronic ischemic heart disease. The data obtained may form a baseline for the forthcoming studies.
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.
Background and Objectives: In spite of large number of studies conducted so far, sudden cardiac death remains an enigma and relative importance of acute coronary events as a trigger of sudden death is currently unclear. An autopsy study of heart was therefore planned to observe various histomorphological cardiac changes, and to determine the frequency association of acute coronary events and myocardial infarction with sudden death. Material and Methods: A prospective randomized study of two hundred autopsied hearts submitted for postmortem analysis was conducted in the Department of Pathology, PGIMS Rohtak over a period of two and a half years from June 2007 to December 2009. The hearts were examined grossly and microscopically to observe various histomorphological changes and findings were correlated clinically. Results: Out of 200 autopsied hearts, 142 (71%) revealed coronary artery atherosclerosis in one or more vessels. Maximum number of cases (32.5%) revealed three vessel diseases. Significant atherosclerosis (>50% reduction in diameter) was present in 125 (62.5%) cases, while 58 cases (29%) revealed no observable atherosclerotic change. One hundred twenty cases could be categorized under sudden cardiac death, 15.83% revealed changes of acute MI, 40% of healed MI and 44% revealed no change. Conclusion: The ischemic heart disease was found to be the leading cause of death with coronary atherosclerosis being the most significant pathogenetic mechanism and three vessel disease the most common pattern of involvement. Acute coronary events (occlusive or non-occlusive thrombus/ plaque rupture/ haemorrhage) were observed in only 16% of the cases of sudden coronary death.
From 1982 to 1986, 1230 sudden death cases were autopsied in Osaka Medical Examiner's Office. Among them, 810 cases were sudden cardiac deaths (SCD) including coronary heart disease (77%), cardiomyopathy (7%), valvular disease (3%). All SCD cases were dead within 24 hours of the appearance of the fatal symptoms, and most of them (72%) were considered instantaneous death. Many of the fatal symptoms began in bed (31%), at bath (17%), at toilet (8%), or at work (8%). Thirty-four percent of them were thought by themselves or by their families to be healthy before the death. Hypertension (38%), coronary heart disease (13%) and diabetes mellitus (11%) were the major past history recorded. Microscopic observation of the hearts of 200 cases autopsied in 1986 showed various cardiac lesions: hypertrophy, atrophy, degenerations of myocytes, cellular and fatty infiltrations of the interstitium. According to their cardiac lesions and degrees of severity of coronary sclerosis, patients who died suddenly were divided into 8 groups as follows: 1. myocardial infarction (41) 2. myocarditis (6) 3. hypertrophic cardiomyopathy (19) 4. chronic ischemia with severe coronary sclerosis (65) 5. chronic ischemia with moderate coronary sclerosis (27) 6. small vessel disease (18) 7. amyloidosis (1) 8. unknown (23). These results suggest that coronary heart disease and hypertension play an important role in SCD.
This review will reconsider the current paradigm for understanding the critical, final steps in the progression of atherosclerotic lesions. That scheme, largely an outgrowth of observations of autopsy tissues by Davies and colleagues,1 2 asserts that the cause of death in atherosclerotic coronary artery disease is rupture of an advanced atherosclerotic lesion. Although this assumption may be partially true, recent autopsy studies suggest that it is incomplete.
To reconsider this paradigm, we reexamined the morphological classification scheme for lesions proposed by the American Heart Association (AHA).3 4 This scheme is difficult to use for 2 reasons. First, it uses a very long list of roman numerals modified by letter codes that are difficult to remember. Second, it implies an orderly, linear pattern of lesion progression. This tends to be ambiguous, because it is not clear whether there is a single sequence of events during the progression of all lesions. We have therefore tried to devise a simpler classification scheme that is consistent with the AHA categories but is easier to use, able to deal with a wide array of morphological variations, and not overly burdened by mechanistic implications.
The current paradigm is based on the belief that type IV lesions, or “atheromas,” described by the AHA are stable because the fatty, necrotic core is contained by a smooth muscle cell–rich fibrous cap. Virchow’s analysis5 in 1858 pointed out that historically, the term “atheroma” refers to a dermal cyst (“Grutzbalg”), a fatty …
Mechanisms of sudden cardiac death (SCD) in subjects with apparently normal hearts are poorly understood. In survivors, clinical investigations may not establish normal cardiac structure with certainty. Large autopsy series may provide a unique opportunity to confirm structural normalcy of the heart before reviewing a patient's clinical history.
We identified and reexamined structurally normal hearts from a 13-year series of archived hearts of patients who had sudden cardiac death. Subsequently, for each patient with a structurally normal heart, a detailed review of the circumstances of death as well as clinical history was performed. Of 270 archived SCD hearts identified, 190 were male and 80 female (mean age 42 years); 256 (95%) had evidence of structural abnormalities and 14 (5%) were structurally normal. In the group with structurally normal hearts (mean age 35 years), SCD was the first manifestation of disease in 7 (50%) of the 14 cases. In 6 cases, substances were identified in serum at postmortem examination without evidence of drug overdose; 2 of these chemicals have known associations with SCD. On analysis of ECGs, preexcitation was found in 2 cases. Comorbid conditions identified were seizure disorder and obesity (2 cases each). In 6 cases, there were no identifiable conditions associated with SCD.
In 50% of cases of SCD with structurally normal hearts, sudden death was the first manifestation of disease. An approach combining archived heart examinations with detailed review of the clinical history was effective in elucidating potential SCD mechanisms in 57% of cases.
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