Sudden death

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Transcript of Sudden death

  • 1. 1
  • 2. Definition Unexpectedly death within 24 hrs from onset of symptoms with or without known preexisting conditions. In forensic view most of cases occur within minutes or even seconds from onset of symptoms. 2
  • 3. SUDDEN DEATH There are no obvious criminal or accidental causes, and becomes of some concern to the forensic pathologist simply because of the difficulty or even impossibility to furnish a certifiable cause of death. The numerous causes of sudden natural death may conveniently be classified according to the different anatomical systems of the body. 3
  • 4. Causes of sudden death Cardiovascular System Respiratory System Gastrointestinal System Gynecological conditions Central Nervous System Other 4
  • 5. Heart The heart of an adult Indian Male 275-300 g Female 225-250g Thickness Atrial wall 1-2 mm Right ventricle 3-5 mm Left ventricle 10-15 mm Layers of the heart Outer epicardium Middle myocardium Inner endocardium Heart enclosed by visceral and parietal pericardium 5
  • 6. Blood supply The Left Coronary Artery: originating from the left aortic sinus, after a short course, bifurcates into: Left anterior descending which runs in the anterior inter-ventricular groove, provides blood to anterior left ventricle, the adjacent anterior right ventricle and anterior two thirds of the inter-ventricular septum Left circumflex branch, which runs in left atrio- ventricular groove, supplies the lateral wall of the left ventricle 6
  • 7. Blood supply The Right Coronary Artery runs in the right atrio-ventricular groove. It usually nourishes the remainder of the right ventricle and the postero-septal region of the left ventricle, including the posterior third of the inter- ventricular septum. 7
  • 8. The localization of atheroma or thrombus Left anterior descending (left anterior inter- venrticular) (45-64%) Right main coronary (45-46%) Left circumflex coronary (3-10%) Left main coronary (0-10%) 8
  • 9. Type of occlusion Simple atheroma Ulcerative atheroma Sub-intimal hemorrhage Coronary thrombosis Per arteritis Nodosa 9
  • 10. Ischemic Heart Disease Interruption or interference with the blood flow to the heart along the coronary arteries will have profound effects on the heart itself In the extreme-the heart will suddenly cease functioning In less extreme, areas of the heart will fail which in turn causes a chain reaction and finally the complete heart failure. At autopsy, one or more of the main branches of the two coronary arteries may show of severe disease process. There will be a deposition of soft white or yellow necrotic fatty material on the lining of the arteries.
  • 11. Ischemic Heart Disease Myocardial infarction occurs when there is 70% blockage or more in the lumen of one or more of the main coronary arteries. 11
  • 12. Cardiac temponade Cardiac tamponade is caused by a large or uncontrolled pericardial effusion due to trauma or after subacute setting after myocardial infarction (heart attack) which result in pressure on the heart muscle. 12
  • 13. Hypertensive Heart Disease An enlargement of the left ventricle of the heart with accompanying increase in the thickness of the muscle wall will result in a raise blood pressure, frequently to a level twice as high as normal. So that, rupture of vessels is frequently seen in the presence of hypertension raised blood pressure, example: rupture of a cerebral artery. 13 The cardiac enlargement almost limited to the left ventricle, the three remaining usually within normal size. In many cases the cause for cardiac enlargement is unknown, when the term primary or essential hypertension is used.
  • 14. Hypertensive Heart Disease HTN may kill person in a number of ways : Cerebral stroke Renal failure Rupture aneurysm Primary HF called cardiac asthma or paroxysmal nocturnal dyspnea produced by the massive pulmonary oedema due to HTN Weght of heart >400g 14
  • 15. Aortic Valve disease Sudden death result because of the hypertrophied left ventricle to force the blood through the diseased and narrowed valve. An alternative reason is that the disease process may spread out from the valve and impede the entry of blood into the ostia of the nearby coronary arteries. 15
  • 16. Hypertrophic obstructive cardiomyopathy (HOCM) Hypertrophic obstructive cardiomyopathy (HOCM) is a disease that results in abnormal thickening of the myocardium most commonly in the interventricular septum HOCM can result in clinical heart failure, life-threatening arrhythmias, mitral regurgitation and sudden cardiac death. 16
  • 17. Sequence of Coronary occlusion Sudden Death Myocardial Infarction Arrhythmia Left ventricular failure and cardiogenic shock Rupture of the Myocardium aneurysms Myocardial Fibrosis Mural Thrombosis and Embolism Pericarditis Post-myocardial Infarction Syndrome (Dressier Syndrome) 17
  • 18. RESPIRATORY SYSTEM The main causes are: 18 Pulmonary Embolism massive haemorrhage in the air passages pneumothorax asthma
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  • 20. Pulmonary Embolism Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream (embolism) especially from deep vein thrombosis (DVT). Usually results after prolonged immobilization, pregnancy, obesity, catheterization (endothelial injury). 20
  • 21. Haemorrhage in the Air Passages When a massive haemorrhage occurs into the major air passages due to trauma, death results from an obstruction to normal respiratory gaseous exchange. Erosion of a large pulmonary vessel by a malignant tumor or by an expanding pulmonary infection (TB). 21
  • 22. Pneumothorax The spontaneous rupture of an emphysematous bulla on the periphery of a lung. e.g.: following a bout of coughing or straining during some physical exertion, can be lead to a massive escape of air into one of the pleural cavities. The vacuum normally present is lost and there is an immediate collapse of the affected lung. In the absence of special medical equipment death may rapidly ensue, especially if there is concomitant disease in the other lung in the heart. 22
  • 23. Asthma Asthma is the sudden and prolonged spasm of the smooth muscles in the walls of bronchioles. The bronchospasm causes sever constriction of the air passages. In the case, the death is due to respiratory failure in the exchange of oxygen and carbon dioxide within the lungs. This may due to obstruction in the airways, restriction in the ability to expand the lungs, allergic neuromuscular problems and ventilation abnormalities. 23
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