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definition of sudden death Unknown causes (non diagnosed )Fast (short term death ) during 24 hNatural death (no traumatic evidences )Unexpected (apparently healthy body )Medical understood

Suspected death

Sudden death with criminal suspicionAll Sudden death is Suspected.but not all Suspected Is suddenSome cases : - smothering (infants- elder ) - some cases of poisoning - some cases of traumatic injuries of head

Classification of sudden death casesSudden infant death (up to 6 month age )Sudden death in early childhood ( 6 m 6 year) - viral infections (cephalo-meningitis ; enteritis ; bronchitis) - visceral inversion iliocolic introsusception Sudden death in school age (6 - 12 year ) - rheumatic cardiac diseases - cardiac deformationsSudden death before puberty (12 18 ) almost rare - neuropathy D - rheumatic cardiac diseasesSudden death of adults

Sudden infant death (SID s)

2 W- 6 m ageSlept -Healthy babiesMale > femaleAlmost during autumn & springIn poor environment & marasmatic babies

Deferential diagnose of SIDsAccidental smotheringCriminal smotheringIntended neglect

Mechanism & causes

Hyper sensitivityViral infectionsImmuno- system disordersDystrophy of internal layer of vessels ( sleeping on face )

Sudden death of adults(cardio-vascular causes )Myocardial Ischemic D (MID)Aortic StenosisSenile Myocardial DegenerationPrimary Myocardial DHypertensionAneurismIntracranial haemorag

MIDInclude : 2 groups 1- organic diseases of coronary system: - coronary thrombosis - coronary stenos by ruptured atherosclerosis board - myocardial infarct by completely coronary occlusion 2- functional diseases : - coronarism - damage of conducting system (pace-making nodes )

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Macro pathological changes in MID

All changes appear only if the patient keep alive more than 8 hours1- after 8 hours :red-yellowish swollen area rounded by petechial hemorrhages2- after 2-3 days :Grey- yellowish hard area lower than around3- after 3-7 days :Light-grey scar then tend to white coloration

Laboratorial diagnose of MID

Micro scope (histopathology ) investigationsK > 51 m.mol / l ( blood of right ventricle )Na/k > 0.7Tropunin t-I ; SGPT ; SGOT Myo -globin in pericardial fluid

Early causes of death by MID

ArrhythmiaCardiac shookPain shookPulmonary oedema ( during recovery )

Late causes of death by MID complications Rupture of infarct area ( 3- 10 days )Valve- failer (Rupture of papillary muscles )Rupture of interventricular septumCardiac aneurysmArrhythmiaThrombosis & embolism

Aortic Stenosis

Affects males over 60 years old or younger with bicuspid V.Ventricular hypertrophy > 700 gAortic Stenosis + Ventricular hypertrophy Blood insufficient

Hypertensive heart diseaseLeft Ventricular hypertrophy > 600 gUnstable, irritable endocardial cells arrhythmia , fibrillationAtheroma is often associated with hypertension

Senile Myocardial Degeneration

The heart is smallThe surface vessels are tortuousThe myocardium is soft & brown

Primary Myocardial DInclude : 1- moycarditis ( diphtherial viral sarcoid) 2- isolated Fiedler myocarditis 3- cardiomyopathy : A- hypertrophic , obstructive type (HOCM) B- congestive type (CCM) ( dilation of chambers )description of cardiomyopathy : 1- asymmetric thickening of ventricular walls 2-cardiomegaly > 1000g 3- microscopic disorder of myocardial fibers

AneurismAtheromatous aneurism of the aorta : - common in elderly males - common in abdominal region of aorta - by autopsy : retroperitoneal hemmhoragDissecting aneurism of the aorta Syphilitic Aneurism of the aorta Berry aneurism : - young to middle age - congenital - in the circle of Willis - by autopsy : subarachnoid H

Intracranial haemmoragcerebral H.Common in old age with significant hypertensionOften in external capsule of hemisphere ( Charcot-Bouchard A.)Can occur in cerebellum ; mid-brain cerebral thrombosis &infarctionCerebro vascular accident (CVA) is rare cause of S.D

Respiration systemPulmonary embolism : traumatic 80% ; non traumatic 20%Massive haemoptysis from cavitating tuberculosis

Gastrointestinal systemSever bleeding from gastric or duodenal peptic ulcerMesenteric thrombosis & embolismStrangulated hernia torsion of bowel

Gynecological conditionsComplication of abortion (illegal )Ruptured ectopic gestation