Diabetic Cardiomyopathy: A Forensic Perspective

Abstract

Diabetes mellitus is a common condition affecting both adults and children. Long-standing diabetes is associated with cardiovascular abnormalities such as coronary artery atherosclerosis, microvascular changes, hypertension, kidney disease, and heart failure. Its association with heart failure in the absence of coronary artery disease and hypertension was termed diabetic cardiomyopathy in the 1970s and is believed to account for some of the cardiac mortality in diabetic patients. This entity may be implicated as the cause of sudden cardiac death in the small percentage of diabetic patients in which the autopsy fails to demonstrate evidence of nonketotic hyperosmolar coma, diabetic ketoacidosis, or atherosclerotic and hypertensive cardiovascular disease. Molecular and metabolic alterations have been studied to explain the pathophysiology of this disease.

Keywords: Cardiac hypertrophy; Cardiomyopathy; Cardiovascular disease; Diabetes mellitus; Forensic pathology.

Image 1:

A) Microvascular intimal thickening (H&E, x400), B) Perivascular fibrosis (H&E, x100), C) Interstitial fibrosis (H&E, x200), and D) Cardiac myocyte hypertrophy (H&E, x400) in a 15-year-old male with no history of hypertension, congenital or valvular disease, and no coronary artery atherosclerosis at autopsy. The 380 g heart also showed biventricular dilatation. The diagnosis of diabetic cardiomyopathy was withheld because findings of diabetic ketoacidosis were present.

Image 2:

Characteristic changes of diabetic nephropathy including nodular globules of homogeneous eosinophilic hyaline material located at the periphery of the glomerulus (Kimmelstiel-Wilson nodules, H&E, x400).