Download Sudden death

-
definition of sudden death
 Unknown causes (non diagnosed )
 Fast (short –term death ) during 24 h
 Natural death (no traumatic evidences )
 Unexpected (apparently healthy body )
 Medical understood
Suspected death
 Sudden death with criminal suspicion
 All Sudden death is Suspected.but not all Suspected Is sudden
 Some cases : - smothering (infants- elder )
- some cases of poisoning
- some cases of traumatic injuries of head
Classification of sudden death cases
 Sudden 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 deformations
 Sudden death before puberty (12 – 18 ) almost rare
- neuropathy D
- rheumatic cardiac diseases
 Sudden death of adults
Sudden infant death (SID s)
 2 W- 6 m age
 Slept -Healthy babies
 Male > female
 Almost during autumn & spring
 In poor environment & marasmatic babies
Deferential diagnose of SIDs
 Accidental smothering
 Criminal smothering
 Intended neglect
Mechanism & causes
 Hyper sensitivity
 Viral infections
 Immuno- system disorders
 Dystrophy of internal layer of vessels ( sleeping on face )
Sudden death of adults
(cardio-vascular causes )
 Myocardial Ischemic D (MID)
 Aortic Stenosis
 Senile Myocardial Degeneration
 Primary Myocardial D
 Hypertension
 Aneurism
 Intracranial haemorag
MID
 Include : 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 )
Macro pathological changes in MID
 All changes appear only if the patient keep alive more than 8 hours
 1- after 8 hours :
red-yellowish swollen area rounded by petechial hemorrhages
 2- after 2-3 days :
Grey- yellowish hard area lower than around
 3- after 3-7 days :
Light-grey scar then tend to white coloration
Laboratorial diagnose of MID
 Micro scope (histopathology ) investigations
 K > 51 m.mol / l ( blood of right ventricle )
 Na/k > 0.7
 Tropunin t-I ; SGPT ; SGOT
 Myo -globin in pericardial fluid
Early causes of death by MID
 Arrhythmia
 Cardiac shook
 Pain – shook
 Pulmonary 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 septum
 Cardiac aneurysm
 Arrhythmia
 Thrombosis & embolism
Aortic Stenosis
 Affects males over 60 years old or younger with bicuspid V.
 Ventricular hypertrophy > 700 g
 Aortic Stenosis + Ventricular hypertrophy Blood insufficient
Hypertensive heart disease
 Left Ventricular hypertrophy > 600 g
 Unstable, irritable endocardial cells
arrhythmia , fibrillation
 Atheroma is often associated with hypertension
Senile Myocardial Degeneration
 The heart is small
 The surface vessels are tortuous
 The myocardium is soft & brown
Primary Myocardial D
 Include : 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
Aneurism
 Atheromatous aneurism of the aorta :
- common in elderly males
- common in abdominal region of aorta
- by autopsy : retroperitoneal hemmhorag
 Dissecting 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 haemmorag
cerebral H.
 Common in old age with significant hypertension
 Often in external capsule of hemisphere ( Charcot-Bouchard A.)
 Can occur in cerebellum ; mid-brain
cerebral thrombosis &infarction
Cerebro vascular accident (CVA) is rare cause of S.D
Respiration system
 Pulmonary embolism : traumatic 80% ; non traumatic 20%
 Massive haemoptysis from cavitating tuberculosis
Gastrointestinal system
 Sever bleeding from gastric or duodenal peptic ulcer
 Mesenteric thrombosis & embolism
 Strangulated hernia – torsion of bowel
Gynecological conditions
 Complication of abortion (illegal )
 Ruptured ectopic gestation