Morphological and Histological Evaluation in Suspected Cases of Sudden Cardiac Death: A Cross Sectional Study
DOI:
https://doi.org/10.48165/jiafm.2023.45.4.8Keywords:
Sudden cardiac death, Histopathological examination, Thrombo-atheromatous plaque, MT and VVG staining, Myocardial bridging, Myocardial ischemiaAbstract
During the autopsy, acute plaque changes such as occluding thrombus, atheromatous disruption, or both are seen in more than half of sudden coronary death cases. At the department of Forensic Medicine and Toxicology, we are getting the cases of sudden cardiac death (SCD) frequently for medico-legal autopsy. The majority of these are found to be due to coronary insufficiency which had been unexpected and unexplained on history taking before the autopsy. Even during the autopsy, some cases do not show any evident gross findings and the diagnosis of SCD can only be made by microscopic examination of the heart and after excluding other possible causes of death. Thus, forensic pathologists have a great opportunity to study SCD and its relationship with different organic and functional causes. The authors have conducted this study intending to evaluate the morphological findings and histopathological changes in suspected cases of sudden cardiac deaths. In this cross-sectional study, the gross pathologies were seen as petechial hemorrhage, soldier's patches, coronary occlusion, bridging of coronary arteries, cardiac tamponade, aortic dissection, valvular pathology, and recent or remote changes of ischemia in the myocardium, etc. Most commonly, the coronary artery occlusions were seen in LAD (59%), especially in its proximal portion (47%). Grade I ischemic changes were seen in maximum cases (in 23% cases), followed by Grade III (in 20% cases), then Grade II (in 16% cases) and least as Grade IVischemic changes seen in 2% of cases.
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Myerburg R, Castellanos A, Libby P, Bonow RO, Zipes DP. Braunwald's Heart Disease. A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia: Saunders; 2007. p. 933–974.
Mohan V, Deepa R. Risk Factors for Coronary Artery Disease in Indians. JAPI. 2004 Feb;52(3) 95-7.
Harikrishnan S, Leeder S, Huffman M, Jeemon P, Prabhakaran D. A race against time: The Challenge of Cardiovascular Diseases in Developing Economies. Centre for Chronic Disease Control. 2nd ed. New Delhi, India; 2014. p. 8-54.
Kumar V, Abbas AK, Aster JC, Perkins JA, editors. Robbins basic pathology. In: Blood vessels, Heart.10th ed. Philadelphia, Pennsylvania: Elsevier; 2018. p. 361-469.
Grandmaison DL, Durigon M, Lorin G. Sudden Adult Death: A Medico-Legal Series of 77 Cases between 1995 and 2000. Med Sci Law. 2002 Jul;42(3):225–32.
Cina SJ, Thompson WC, Fischer JR, Brown DK, Titus JM, Smialek JE. A study of various morphologic variables and troponin I in pericardial fluid as possible discriminators of sudden cardiac death. Am J Forensic Med Pathol. 1999 Dec;20(4):333–7.
Chockalingam P, Wilde AA. Inherited arrhythmia syndromes leading to sudden cardiac death in the young: Aglobal update and an Indian perspective. Indian Heart J. 2014 Jan; 66: S49–57.
Porwal V, Khandelwal S, Jain D, Gupta S. Histological classification of atherosclerosis and correlation with ischemic heart disease: A autopsy based study. Ann Pathol Lab Med. 2016 May 8;3(2):A99-104.
Yang KM, Lee SY, Kim YS, Seo JS, Lee YS, Seo JW. Guidelines for forensic assessment of natural unexpected cardiovascular death. Basic Appl Pathol. 2008 Dec;1 (4):155–63.
Jayaraman R, Reinier K, Nair S, Aro AL, Uy-Evanado A, Rusinaru C, et al. Risk Factors of Sudden Cardiac Death in the Young: Multiple-Year Community-Wide Assessment. American Heart Association, Inc. Circular. 2017
Dec;137:1561–70.
Srivatsa UN, Swaminathan K, Sithy AMK, Amsterdam E,
Shantaraman K. Sudden cardiac death in South India: Incidence, risk factors and pathology. Indian Pacing Electrophysiol J. 2016 Jul;16(4):121–5.
Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. Guideline for Management of Patients With Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. AHA, ACC, HRS; 2018
Sep;138:272-391.
Grandmaison DL, Lorin G. Is there progress in the autopsy diagnosis of sudden unexpected death in adults? Forensic Sci Int. 2006 Jan;156(2–3):138–44.
Knight B, Saukko PJ. Knight's Forensic pathology. 3rd ed. London: New York: Arnold ; Distributed in the United States of America by Oxford University Press; 2004. p. 662.
Zhu BL, Ishikawa T, Michiue T, Li DR, Zhao D, Oritani S, et al. Postmortem cardiac troponin T levels in the blood and pericardial fluid. Part 1. Analysis with special regard to traumatic causes of death. Leg Med. 2006 Mar;8(2):86–93.
Bertomeu A, García-Vidal O, Farré X, Galobart A, Vázquez M, Laguna JC, et al. Preclinical coronary atherosclerosis in a population with low incidence of myocardial infarction: cross sectional autopsy study. BMJ. 2003 Sep 13;327 (7415):591–2.
Stary Herbert C. Natural History and Histological Classification of Atherosclerotic Lesions. Arterioscler Thromb Vasc Biol. 2000 May 1;20(5):1177–8.
Stary Herbert C, Chandler A, Bleakley, Dinsmore Robert E, Fuster V, Glagov S, Insull W, et al. A Definition of Advanced Types of Atherosclerotic Lesions and a Histological Classification of Atherosclerosis. American Heart
Association, Inc. Circulation. 1995 Sep 1;92(5):1355–74.
Zipes DP, Wellens HJ. Clinical Cardiology, Sudden Cardiac Death. American Heart Association, Inc. 1998;98:2334–51.
Alegria JR, Herrmann J, Holmes DR, Lerman A, Rihal CS. Myocardial bridging. Eur Heart J. 2005 Jun;26(12):1159–68.
Bourassa MG, Butnaru A, Lespérance J, Tardif JC. Symptomatic myocardial bridges: overview of ischemic mechanisms and current diagnostic and treatment strategies. J Am Coll Cardiol. 2003 Feb 5;41(3):351–9.
Théroux P, Fuster V. Acute Coronary Syndromes: Unstable
Angina and Non–Q-Wave Myocardial Infarction. Circulation. 1998 Mar 31;97(12):1195–206.
Erbel R, Ge J, Möhlenkamp S. Myocardial bridging: a congenital variant as an anatomic risk factor for myocardial infarction? American Heart Association, Inc. Circulation. 2009 Aug;120(5):357–9.
Joo YN, Jong PP, Hye JP, Bong WL, Young SC, Joong SS. The Statistical Analysis on Legal Autopsy Performed in Korea during 2012. Korean J Leg Med. 2013;37:198-207.
Di Maio VJ, Di Maio DJ. Incidence of coronary thrombosis in sudden death due to coronary artery disease. Am J Forensic Med Pathol. 1993 Dec;14(4):273–5.
Mizgala HF, Gray LH, Ferris JA, Bociek V, Allard P, Davies C. Coronary artery luminal narrowing in the young with sudden unexpected death: a coroner's autopsy study in 350 subjects age 40 years and under. Can J Cardiol. 1993 Feb;9(1):33–40.
Joseph A, Ackerman D, Talley JD, Johnstone J, Kupersmith J. Manifestations of coronary atherosclerosis in young trauma victims--an autopsy study. J Am Coll Cardiol. 1993 Aug;22(2):459–67.
Virmani R, Robinowitz M, McAllister HA. Coronary heart disease in 48 autopsy patients 30 years old and younger. Arch Pathol Lab Med. 1983 Oct;107(10):535–40.
Steriotis A, Krexi L, Plonczak A, Finocchiaro G, Papadakis M, Sharma S, et al. 155 Histopathological Study of 62 Sudden Cardiac Death Victims with Isolated Mitral Valve Prolapse.BMJ; Heart. 2016 Jun 1;102(Suppl 6):112.
Noronha SV, Behr ER, Papadakis M, Ohta-Ogo K, Banya W, Wells J, et al. The importance of specialist cardiac histopathological examination in the investigation of young sudden cardiac deaths. EPEur. 2014 Jun;16(6):899–907.
Sree Lakshmi K, Ashalatha N, Raghava VS, Raghupathi AR, Dayananda SB, Siddique M et al. Evaluation of Histopathologic Role in Providing Cause of Death in Sudden Unexpected Natural Death. J Indian Acad Forensic Med. 2014 Jan-Mar, 36(1): 43-6.
Garg S, Hasija S, Sharma P, Kalhan S, Saini N, Khan A. A histopathological analysis of prevalence of various heart diseases: an autopsy study. Int J Res Med Sci. 2018 Mar 28;6(4):1414.
