SUDDEN CARDIOVASCULAR DEATH
Lina Paola AvellaGina CastellanosRaul CastillaFabian GalarzaNatalli RodriguezJulieth SantosXimena Tovar
Contents
Introduction Evaluation on the clinical history Sudden death First article
Cases Discussion
Second article Abstract Discussion
Contents
Third article Abstract Clinical stages of ARCV Clinical Diagnostic Criteria of ARCV
Morphological findings at forensic autopsy Checklist
Histological examination of the heart Examination of the cardiac conduction
system Laboratory test Conclusion
Video
Video
Introduction
Natural deaths > Unnatural deaths. Sudden unexpected deaths
Cardiovascular diseases: 51.8% > 80%: Coronary atherosclerosis.
Introduction
This requires:
Pathologists: Complex task.
Synthesis of scene
investigation
Medical history
Autopsy findings
Auxiliary studies
Formulating the report
Evaluation on the clinical history The first step Six groups of information*
* Association for European Cardiovascular Pathology
Basic personal
data
Circumstances of death
Medical history
Medication use
Family history of cardiac
diseases
Previous test results
Sudden DeathUnexpected
death
Natural Unexpected
death
Natural unexpected
cardiovascular death
*Neural arrhythmia *Mechanical
infarct congestive
failure
“Commotio cordis” Sexual activity
Arrhytmogenic right ventricular cardiomyopahty
Natural unexpected
nervous death*Neural reflex,
seizure*Mechanical herniation
infarct
Natural unexpected respiratory
death*Neural apnea*Mechanical embolism asphyxia
Un-natural death
Suicide Accident Criminal
Cases
Discussion
Abstract
Discussion
Arrhythmogenic right ventricular cardiomyopathy (ARCV)
Young Adults
Cause of sudden death in this age group
Without prior history
Clinical Stages of ARCV
IConcealed
phase
• Whitout symptoms• Minor electrical disturbances• Impending risk of sudden death
IIOvert phase
• Arrhythmic disorders• Ventricular tachycardia
IIIAdvanced stage
•Myocardial loss•Dilated cardiomyopathy
Clinical Diagnostic Criteria of ARCV
Pathology Clinical History
Tissue characterization of wall
Depolarization abnormalities Family history
Global/regional dysfunction
Structural alterations
Repolarization abnormalities
arrhythmias
Common morphological findings at forensic autopsy Atheroesclerotic Narrowing of
coronary arteries
Myocardal Scar Dissection of coronary Arteries Examinate lungs
Proximal left Anterior desending A.
Left circumflex coronary A.
Standard prodedure for examination of heart (checklist)
Pericardium and pericardial cavity. Anatomy of the great arteries
Valves and trunk
Pulmonary
Aorta
Standard prodedure for examination of heart (checklist)
Pulmonary veins, superior and inferior veane cavae.
Open Incision
Left Atria
Inferior V. cava to apex of the
appendage
Pulmonary veins to atrial
appendage
Right Atria
Standard prodedure for examination of heart (checklist)
Sinus Node
Esta pendiente una foto mas bonita en donde se mire auricaulas , septum interauricular, y valvul mitrla y tricuspidea se r eciben sugerencias
Standard prodedure for examination of heart (checklist)
Aorta and pulmonary artery including valves
Coronary Arteries
Size Shape Position NumberCourseDOMINANCE
Standard prodedure for examination of heart (checklist)
Coronary Arteries
Make multiple cuts at 3mm intervals along epicardial
A.
Arteries again after fixation
Standard prodedure for examination of heart (checklist)
Ventricular DisectionStandard Incision through the blood Flow
Transv. Cut of heart at mid ventricular level and parallel slices 1 cm
Sectioning at inflow of heart throug left and right AV valves.
Foto pendiente
Anatomy heart, ischemic, congeital lesions
Morphology of walls and cavities
Small heart fetus rarely adults autopsy
Standard prodedure for examination of heart (checklist)
Total Heart weight Wall thikness Heart Dimension
Standard histological examination of the heart Myocardium
Coronary Arteries
Right atria and vetricularLeft atria and ventricular
Ventricular septumMacroscopic abnormalities
Focal Lessions
Examination of the cardiac conduction system Some cases of apparent NUCD
without gross cardiac abnormality. Rare to find lesions at nodes Blood suply of Nodes before take
samples for histology studies. Sinus / Atrioventicular Nodal Artery ¼ Cranial Right atrial wall of terminal
groove: Sinus Node
Cardiac conduction system
Images of nodal and atrioventricular artery
Image of the ¼ right atrial wall
Cardiac conduction system
Triangle of Kock Anterior half of septal leaflet of
tricuspid valve for histology
Image of kock`s triangle and sample for histology
Cardiac conduction system
Electrophisiologic studies with reentry of miocardial conduction. Radiofrecuency Ablation
Lethat lesions: Narrowing of AV Node Artery
Fibromuscular Hiplerplasia
AV Node Tumors
Laboratory Test
Creatine phosphokinase and isoenzymes
Rised in deaths of cardiac disease Early MI without evidence on routine
histological examination Measurement in blood and
pericardial fluid Before macro-microscopic evidence
of MI Combined Morphological,
Histochemical and Biochemical methods
Toxicology
Depending circumstances surrounding the death and tox. data the manner can be accidental, natural or criminal
Even with findings, may have a substance triggered or caused the death?
Young- athlets: Doping or recreational drugs
Molecular Pathology
Almost 1/3 of cases have as cause of sudden death
Pathogenic mutation in long QT syndrome
Cathecolaminergic polymorphic ventricular tachycardia = associate genes
High Risk Groups
Medical conditions : History of MI or Isquemic Heart Disease, Hipertension, Aortic Stenosis.
Morbid Obesity: Dilated cardiomyopathy Severe coronary atherosclerosis Concentric left ventricular hipertrophy Young predispose by vigorous weight
training + anabolic steroids use to Myocardial injury or even SD
Conclusion
Any Question?
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