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Transcript
- 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