Sudden Cardiac Death
Anubha Bajaji*
Histopathologist in A.B. Diagnostics, New Delhi, India
Submission: October 27, 2017; Published: November 21, 2017
*Corresponding author: Anubha Bajaji, Histopathologist in A.B. Diagnostics, New Delhi, India, Email: anubha.bajaj@gmail.com
How to cite this article: Anubha B. Sudden Cardiac Death. Adv Res Gastroentero Hepatol 2017; 7(5): 555725. DOI:10.19080/argh.2017.07.555725
Introduction
Sudden deaths are classified as:
1) Truly sudden deaths: which occur in seconds to a few minutes & are generally observed.
2) Unexpected deaths: which are unobserved & may be sudden or prolonged.
Pathologic lesions associated with sudden cardiac death
a. Ventricular Fibrillation
b. Coronary thrombosis/ Sclerosis
c. Miscellaneous lesions such as aortic stenosis, viral myocarditis, hypertensive cardiomyopathy, ruputured acute infarct with tamponade.
Congestive heart failure from
a. Myocardial Infarction
b. Arteriosclerotic Heart Disease
c. Rheumatic Valvulitis with stenosis / insufficiency
d. Bacterial Endocarditis
e. Alcoholic Cardiomyopathy
f. Cardiac ARGHhythmias with presumptive aetiologies
g. Congenital causes such as WPW syndrome with H/O medically established episodes of cardiac ARGHhythmias.
The autopsy procedure should include examination of the heart especially the coronaries. Numerous sections from various areas should be taken including the conducting system for histology.
Sudden Unexpected Death in Infancy
i. Possible Pathologic Lesions in Infancy associated with sudden death (Though their presence precludes the very definition of sudden death in infancy). Viral Myocarditis
ii. Ventricular Fibrillation (Electrical shock induced)
iii. Air Embolism
iv. Intracerebral Heammorrhage (Secondary to Injury)
v. Foriegn Body Obstruction- Larynx
vi. Laryngospasm/ Laryngeal Edema
vii. Anaphylaxis as a rare cause
viii. Rheumatic Valvulitis leading to Insufficiency
ix. Meningitis with Septiceamia
x. Brain Tumors prepondrant in Infancy e.g. AV Malformations, Neurocutaneous Melanosis with Internal Hydrocephalus, Medulloepithelioma, Medulloblastoma, Pilocytic Astrocytoma
xi. Acute Pyelo nephritis with Septiceamia
xii. Congenital/Childhood Renal diseases(Cystic diseases- Renal Dysplasia, Infantile Polycystic Disease, Congenital Nephrotic Syndrome, Renal tumors-Mesoblastic Nephroma, Multicystic Nephroma)
xiii. Pneumonitis with Septicaemia
xiv. Sickle Cell Crisis, Congenital Leukaemia
xv. Electrolyte Imbalances due to Gastroenteritis/ Dehydration
xvi. Sudden death associated with seizure disorder Cardiac conduction defects such as WPW syndrome
Points to be Considered During the Autopsy (Diagnostic & Erroneus)
a. Circumstantial Evidence (such as neck compression, suffocation, traumatic asphyxia).
b. Fatal child abuse - bruised, malnourished, dirty, skeletal fractures.
c. Blood exam for sedatives/salicylates etc.
d. Carbon Monoxide Intoxication.
e. Agonal Aspiration of gastric contents should not be taken as cause of death.
f. Post mortem refrigeration of infants congeals the subcutaneous fat in the neck causing a crease commonly mistaken as a ligature strangulation mark, but no associated bruising / contusion seen.
g. Nasal/perioral abrasions along with visceral laceration & head injury seen as a spectrum of Resuscitation Injuries.