Morphological Array of Cardiac and Coronary Artery Diseases in Cases of Sudden Death: An Autopsy-Based Histopathological Study in Rural Setup

Authors

  • K Subathra Associate professor,Department of Pathology, Theni Government Medical College, Theni.
  • M R Gokula Pandiasankar Department of Forensic Medicine, Theni Government Medical College, Theni.
  • D Kavitha Department of Pathology, Theni Government Medical College, Theni.
  • R Shobana Department of Pathology, Theni Government Medical College, Theni.

DOI:

https://doi.org/10.48165/

Keywords:

Aortic dissection, Coronary atherosclerotic disease, Infective endocarditis, Left ventricular hypertrophy, Myocardial infarction

Abstract

Cardiovascular diseases are the foremost cause of sudden death in adults. The primary objective of this study is to estimate the prevalence  of various cardiac and coronary artery diseases in sudden unexpected death cases in rural setup. Estimation of age and sex-wise frequency  of coronary atherosclerotic disease (CAD), and grading of CAD by applying the Modified American Heart Association (AHA)  classification are secondary objectives. In this three years prospective cross-sectional study, heart specimens were studied from 136  persons whose death was sudden and unexpected. Gross dissection and histopathological examination of coronary arteries and heart were  done. Diagnoses were based on both gross and microscopic findings.  CAD with or without other diseases was the most frequent pathology (n-100, 73.5%). Left ventricular hypertrophy in 45 cases (33.09%),  myocardial infarction in 30 cases (22.06%), valvular abnormalities in three cases (2.2%), infective endocarditis in two cases (1.47%),  aortic dissection in one case (0.74%), right ventricular hypertrophy in one case (0.74%) and cardiac myocyte atrophy in one case (0.74%)  were observed. Male-female ratio of CAD was 8.09:1. Advanced CADs (type IV, V, VI) were found in 94 (94%) cases. In males, the  maximum number of advanced CAD was observed in the fifth decade (n- 27, 31.76%) and in females in the seventh decade (n- 4, 44.44%).  This study reveals the increasing trend of CAD in rural populations. This study adds rare entities like young-age aortic dissection and  cardiac myocyte atrophy to the existing literature and emphasises the importance of autopsy in sudden death cases.

References

Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel). 2021; 9:870.

Dettmeyer RB, Verhoff MA, Schütz HF. Special Case Constellations in Natural, Unexplained, and Unnatural Deaths. In: Forensic Medicine: fundamentals and perspectives. Heidelberg: Springer; 2014.p 417.

Stary HC, Chandler AB, Dinsmore RE, Fuster V, Glagov S, Insull W Jr, et al. A definition of advanced types of atherosclerotic lesions and a histological classification of atherosclerosis. A report from the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association. Circulation. 1995;92:1355-74.

Park K. Park's Textbook of preventive and social medicine. th In: Cardiovascular diseases. 26 edition. Jabalpur: M/s Banarsidas Bahanot publishers; 2021.p411-419.

Rani E, Kumar S, Mehrolia V. Morphological pa tt e rns in heart diseases-an autopsy study. International Journal of Current Advanced Research. 2017;6: 5391-5393.

Udasimath S, Nagesha KR, Ramaiah P. Morphological Changes of Coronary Arteries in Cases of Sudden Death due to Cardiac Causes - An Autopsy-Based 10-Year Retrospective Study. Heart Views. 2021;22:189-195.

Gaiwale SD, Madhusudan R. Petkar, Vandana S. Gundla et al. Autopsy Profile of sudden Cardiac Deaths Reported in Mumbai region of Maharashtra. Indian J Forensic Med Pathol. 2019;12(1):25-28.

Patil S, Zamad P, Jungare A, Nasare A, Umap P, Rudra P. Autopsy findings in sudden cardiac death victims at a tertiary health care centre. J Indian Acad Forensic Med. 2021; 43(1): 51-54.

Dayananda R, Pradhan P, Kumar MP. Pattern of Sudden Natural Deaths among Autopsies Conducted at Mysore Medical College. J Indian Acad Forensic Med. 2018; 40( 2): 146-150.

Rao D, Sood D, Pathak P, Dongre SD. A cause of Sudden Cardiac Deaths on Autopsy Findings; a Four-Year Report. Emerg (Tehran). 2014;2:12.

Rajahan DG, Sneha S, Pradhan PP, Kumar SP, J. Thanka. Grading and occurrence of coronary artery stenosis in different age groups-an autopsy based study. J Indian Acad Forensic Med. 2021; 43(4): 354-356.

Bhanvadia VM, Desai NJ, Agarwal NM. Study of Coronary Atherosclerosis by Modified American Heart Association Classification of Atherosclerosis-An Autopsy Study. Journal of Clinical and Diagnostic Research. 2013;7:2494-2497.

Kumar S, Kumar VA, Kumar N, Baranwal RK, Kumar VR, Singh M. Coronary atherosclerosis - a postmortem histopathological study. Bratisl Lek Listy. 2012;113:217- 219.

Sudha ML, Sundaram S, Purushothaman KR, Kumar PS, Prathiba D. Coronary atherosclerosis in sudden cardiac death: An autopsy study. Indian J Pathol Microbiol. 2009;52:486- 489.

Siddiqui MI, Mahanta AA, Umesh SR, Neeha S, Andola SK. Morphological study of the spectrum of lesions encountered in the heart and coronaries on autopsy. Indian J Pathol Microbiol. 2022;65:18-22.

Cunningham KS, Spears DA, Care M. Evaluation of cardiac hypertrophy in the setting of sudden cardiac death. Forensic Sci Res. 2019;4:223-240.

Mitchell RN, Connolly AJ, The Heart. In: Kumar, V., Abbas, A. K., & Aster, J. C. Robbins and Cotran pathologic basis of disease. 10 edition. Vol 1. Philadelphia, PA:

t h

Elsevier/Saunders;2021. P507-508.

Fikar CR, Fikar R. Aortic dissection in childhood and adolescence: an analysis of occurrences over a 10-year interval in New York State. Clin Cardiol. 2009;32:E23-E26.

Watt G, Lacroix A, Pachirat O, Baggett HC, Raoult D, Fournier PE et al. Prospective comparison of infective endocarditis in Khon Kaen, Thailand and Rennes, France. The American Journal of Tropical Medicine and Hygiene. 2015;92:871-874.

Roguin N, Du ZD, Barak M, Nasser N, Hershkowitz S, Milgram E. High prevalence of muscular ventricular septal defect in neonates. J Am Coll Cardiol. 1995;26:1545-1548.

Roos-Hesselink JW, Meijboom FJ, Spitaels SE, Van Domburg R, Van Rijen EH, Utens EM et al. Outcome of patients after surgical closure of ventricular septal defect at young age: longitudinal follow-up of 22-34 years. Eur Heart J.2004;25:1057-1062.

Menting ME, Cuypers JA, OpićP, Utens EM, Witsenburg M, van den Bosch AE et al. The unnatural history of the ventricular septal defect: outcome up to 40 years after surgical closure. J Am Coll Cardiol. 2015;65:1941-1951.

Webb JG, Kiess MC, Chan-Yan CC. Malnutrition and the heart. Canadian Medical Association Journal. 1986;135:753- 758.

Downloads

Published

2023-12-05

Issue

Vol. 45 No. 1 (2023): Journal of Indian Academy of Forensic Medicine (Jan-Mar) 2023

Section

Articles

How to Cite

Morphological Array of Cardiac and Coronary Artery Diseases in Cases of Sudden Death: An Autopsy-Based Histopathological Study in Rural Setup . (2023). Journal of Indian Academy of Forensic Medicine, 45(1), 85–90. https://doi.org/10.48165/