Sudden cardiac death-update

Abstract

Sudden cardiac death (SCD) is one of the most common causes of death worldwide with a higher frequency especially in the young. Therefore, SCD is represented frequently in forensic autopsy practice, whereupon pathological findings in the heart can explain acute death. These pathological changes may not only include myocardial infarction, coronary thrombosis, or all forms of myocarditis/endocarditis but also rare diseases such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system, or primary cardiac tumours.

Keywords: Acute death; Common cause of death; Death in the young; Forensic aspects; Sudden cardiac death (SCD).

Fig. 1

Highly stenosing fibromuscular dysplasia of the AV nodal artery with broad connective tissue thickening of the vessel wall and partial destruction of the lamina elastica interna without inflammatory component (Elastica van Gieson staining (EvG), × 40)

Fig. 2

Congo red positive amyloid plaques found in the myocardium with surrounding low lymphomonocyte-infused fibrosis (Congo red staining, × 200)

Fig. 3

Focal infiltration of the myocardium with fungal filaments and fungal conidia in fungal myocarditis with myocardial necroses and accompanying partial lymphomonocytic, partly also granulocytic infiltration (Grocott staining, × 200)

Fig. 4

Purulent myocarditis (ASD staining, × 100). Abscess of decaying neutrophil granulocytes and detritus

Fig. 5

Focal and well-demarcated granulomatous infiltration of the myocardium with multinucleated giant cells, dense fibrosis, and accompanying lymphomonocytic infiltration without necrosis zones (haematoxylin–eosin staining (HE), × 100)

Fig. 6

Rheumatoid myocarditis (HE × 200). Aschoff body with granulomatous structures consisting of fibrinoid change, lymphocytic infiltration surrounding necrotic centre

Fig. 7

Good demarcated necroses in the myocardium with dense collections of lymphocytes and monocytes, isolated plasma cells and eosinophil granulocytes for diclofenac myocarditis (HE staining, × 200)