SUDDEN AND UNEXPECTED DEATHS

DEFINITION A person who has been apparently well attending his day to day work dies suddenly and unexpectedly. ( can be within seconds, minutes , hrs or days) WHO death within 24 hrs of onset of symptoms. Circumstances 1. Die following chronic illness. - Die quickly due to sequelae or complication of illness - Death is sudden but not unexpected 2. Die following brief illness Patient without medical care dies suddenly Unexpectedness is due to, - Not aware of the illness - Masking due to 2 or more illness occurring @ the same time - Ignorance - Misinterpretation or rationalization Common in 30-70 yrs of age Not common 1-30 yrs or over 70 yrs of age

SUN DEATHS

CVS CAUSES

NON CVS CAUSES

Chronic alcoholism Chronic IV narcotism HIV/AIDS Morbid obesity Obstructive sleepapnoea Plu. Embolism CNS ( tumour, epilepsy) Respiratory diseases GIT diseases Others

Cardiac causes
a) Coronaries -atherosclerosis - non atherosclerosis b) Non coronaries - Conduction - Myocardium - Valve

non cardiac causes

1. Cerebrovascular 2. Aorta- aneurysms 3. GIT oesophageal varices, peptic Ulcers 4. Haemorrhage due to respiratory causes 5.other causes -ectopic pregnancy -hepatoma -haemangioma - Portal hypertention - splenic rupture

CVS causes of SUN deaths

cardiac causes mechanism 1) SUN cardiac deaths due to coronaries (IHD)
IHD electrically stable electrically unstable pump failure sudden arrhythmias

Electrical instability is due to, a. Hypertensive heart disease with LVH ( cause of death is hypertensive or atherosclerotic heart diseases) b. Due to transient risk factors Transient risk factors cannot seen in autopsy Atherosclerotic coronary HD - confirmed at autopsy by coronary obstruction by atheroma. ( refer path notes) Non atherosclerotic coronary HD Eg: Arterial spasm, arteritis, dissecting aneurysm of coronaries Mechanism of death - Hypoperfusion of the heart, ventricular Arrhythmias MCQ points In HT and DM atheroma in distal epicardial coronary ramifications Congestion is a non specific finding in atherosclerotic coronary heart disease. Congestion leads to more PM hypostasis (due to
agonal unbalanced autonomic discharge than hypovolaemia)

2) SUN cardiac deaths due to non coronaries

1. Conduction system causes. Functional causes- no positive autopsy finding

 Structural causes- may be positive changes 2. Myocardial causes a. Left ventricular hypertrophy( LVH) b. Cardiomyopathies c. Myocarditis refer cvs notes Types of LVH : Concentric Due to increased afterload. No enlargement of chambers. Eg: HT , aortic stenosis, thyrotoxicosis, isometric excersise. Eccentric Hypertrophy with dilatation. Both pre and afterload is increased. Increased total mass but functioning mass is reduced. Asymmetric septal hypertrophy- LVH with obvious dilatation. Eg:AHD, valvular insufficiency, Myocarditis, dilated CMP Pseudohypertrophy - following MI. reduced functioning mass .

Types of MI
I.

Subendocardial Transmural

II.

partial obstruction transient risk factors (MI within 2 normal layers - sandwitchlike ) complete obstructiondue to acute changes of Atherosclerotic plaque

3. Valvular heart diseases Calcific aortic stenosis most common ( senile or congenital bicuspid aortic valve) Mitral valve prolaps.

Non CVS causes / haemorrhagic

Mechanism 1. Rapid loss of about 1/3 of circulating blood 2. Creating increased pressure on or in a vital organ

Eg: haemopericardium.,ICH Types a. Spontaneous intracranial haemorrhage. HT, atherosclerosis Spontaneous SAH - rupture of berry aneurysm, arteriovenous malformation b. Diseases of aorta- dissecting aneurysm c. GIT Oesophageal varices, peptic ulcers d. Haemorrhage due to respiratory causes- hypovolaemic shock, asphyxia

1)Regarding SUN deaths, a. Psychosis may mask fatal pathology thus resulting SUN deaths. b. Are more common after 80 yrs of age. c. Do not occur as a sequelae of a chronic illness. d. Death is always instantaneous. e. Hypercholesterolaemia is a risk factor. T F F F T WHO- within 24 hrs of onset of symptoms Cause of sudden cardiac death Common in 30- 70 yrs of age

2 ) regarding sudden cardiac death, a. Electrically stable hearts are less prone to get arrhythmias. b. Deaths due to arrhythmias show negative findings at the autopsy. c. Hypertrophied heart is electrically unstable d. Transient risk factors cause sudden deaths in a patient with partially obstructed coronaries. e. Cardiac tamponade overall risk is more common in young females T T T T F Females are at more risk but it increases with the age too. Theyre more prone to get pump failure

3 ) T/F regarding SUN deaths a. Atheroma in proximal coronary ramifications are common in a patient with DM b. Congestion is a non specific PM finding of a death due to AHD. c. Subendocardial MI is seen as area of infarction between two normal tissue areas. d. Collagen vascular disease may give rise to disturbances of conduction system. e. Pseudohypertrophy results in increased functional mass of myocardium. T F T T F Myocardial layer immediately next to the heart chambers are spared due to direct diffusion of O2 from blood in the chambers. Due to increased haemodynamical stress at the ramifications