The Challenge of Diagnosis: Cardiac Tamponade Identified at Autopsy.
Keywords:
Cardiac Tamponade; Myocardial infarction (MI); Sudden natural deathAbstract
There has been a rise in the incidence of sudden death among individuals in middle age. Predominantly, cardiovascular diseases have seen to be the most leading cause behind such deaths. Despite being a relatively uncommon presentation, cardiac tamponade presents as one of the rare yet fatal complications. This condition manifests when the pericardial cavity becomes filled with either blood or blood clots, compromising the heart’s normal contractile function. Typically, patients experiencing cardiac tamponade are often reported to have succumbed to sudden death, with history of chest pain. The definitive diagnosis of cardiac tamponade usually occurs during post-mortem examinations during Autopsy. We consider the case of a 45-year-old man who was found unconscious at his residence and was pronounced dead upon arrival at the hospital. Subsequent autopsy findings unveiled the presence of both blood and blood clots within the pericardial cavity, in conjunction with a rupture in the left ventricle and occlusion of the right coronary artery. Histopathological examination further confirmed the root cause of this fatal event as an acute myocardial infarction.References
Patil A, Singh N, Vigneshwaran S, Bharti S, Sudhakar S. Sudden death due to cardiac tamponade secondary to myocardial infarction ventricular wall rupture. Cureus. 2022;14(10):e30288. doi:10.7759/cureus.30288.
Chhabra HS, Kumar A, Kaur N, Chhabra DS. Cardiac tamponade and its medicolegal aspects: A case report. Med Leg J. 2021;89(2):145–147. doi:10.1177/0025817220980680.
Sonwani NS, Ateriya N, Kumar A. Dying from haemorrhagic cardiac tamponade – A case series. Med Leg J. 2019;87(4):210–214. doi:10.1177/0025817219867268.
Kondo T, Nagasaki Y, Takahashi M, Nakagawa K, Kuse A, Morichika M, et al. An autopsy case of cardiac tamponade caused by a ruptured ventricular aneurysm associated with acute myocarditis. Leg Med (Tokyo). 2016;18:44–48. doi:10.1016/j.legalmed.2015.12.002.
Alerhand S, Adrian RJ, Long B, Avila J. Pericardial tamponade: A comprehensive emergency medicine and echocardiography review. Am J Emerg Med. 2022;58:159–174. doi:10.1016/j.ajem.2022.05.001.
Spodick DH. Acute cardiac tamponade. N Engl J Med. 2003;349(7):684–690. doi:10.1056/NEJMra022643.
Angel S, M V, Pradhan P. Cardiac tamponade and myocardial infarction: A case report. Cureus. 2024;16(6):e63284. doi:10.7759/cureus.63284.
Slater J, Brown RJ, Antonelli TA, Menon V, Boland J, Col J, et al. Cardiogenic shock due to cardiac free-wall rupture or tamponade after acute myocardial infarction: A report from the SHOCK Trial Registry. J Am Coll Cardiol. 2000;36(3 Suppl A):1117–1122. doi:10.1016/S0735-1097(00)00845-7.
Tsukube T. Decision making and management of acute type-A dissection presenting with shock or cardiac arrest. Asian Cardiovasc Thorac Ann. 2023;31(1):20–25. doi:10.1177/02184923211060574.
Huang L, Li T, He ZZ, Liu YW. Acute hemorrhagic cardiac tamponade as presenting findings of transmural myocardial infarction in an adult patient. Chin Med J (Engl). 2016;129(5):618–619. doi:10.4103/0366-6999.176990.
Reddy KSN, Murthy OP. The Essentials of Forensic Medicine & Toxicology. 35th ed. New Delhi: Jaypee Brothers Medical Publishers; 2022. p. 206.
Satish NT, Shetty ARS, Harish S, et al. Sudden death due to cardiac tamponade – A case report. Int J Health Sci Res. 2014;4(6):239–243.
Eranti A, et al. Spontaneous cardiac tamponade as a cause of sudden unexpected death with focus on coronary aneurysms. J Soc Cardiovasc Angiogr Interv. 2024;3(1).
