Document Type : Original Research
Authors
Dept. of Pathology, Pt. B.D.Sharma PGIMS, Rohtak, India
Abstract
Background and Objectives: In spite of large number of studies conducted so far, sudden cardiac death remains an enigma and relative importance of acute coronary events as a trigger of sudden death is currently unclear. An autopsy study of heart was therefore planned to observe various histomorphological cardiac changes, and to determine the frequency association of acute coronary events and myocardial infarction with sudden death.
Material and Methods: A prospective randomized study of two hundred autopsied hearts submitted for postmortem analysis was conducted in the Department of Pathology, PGIMS Rohtak over a period of two and a half years from June 2007 to December 2009. The hearts were examined grossly and microscopically to observe various histomorphological changes and findings were correlated clinically.
Results: Out of 200 autopsied hearts, 142 (71%) revealed coronary artery atherosclerosis in one or more vessels. Maximum number of cases (32.5%) revealed three vessel diseases. Significant atherosclerosis (>50% reduction in diameter) was present in 125 (62.5%) cases, while 58 cases (29%) revealed no observable atherosclerotic change. One hundred twenty cases could be categorized under sudden cardiac death, 15.83% revealed changes of acute MI, 40% of healed MI and 44% revealed no change.
Conclusion: The ischemic heart disease was found to be the leading cause of death with coronary atherosclerosis being the most significant pathogenetic mechanism and three vessel disease the most common pattern of involvement. Acute coronary events (occlusive or non-occlusive thrombus/ plaque rupture/ haemorrhage) were observed in only 16% of the cases of sudden coronary death.
Keywords
- Audibert L, Fauchon M, Blanc N, Hauchard D, Gall EA. Phenolic compounds in the brown seaweed Ascophyllum nodosum: distribution and radical-scavenging activities. Phytochem Anal 2010 21(5):399-405.
- Kwok KM, Lee KL, Lau CP, Tse HF. Sudden cardiac death: prevention and treatment. Hong Kong Med J 2003; 9(5):357-62.
- Farb A, Tang AL, Burke AP, Sessums L, Liang Y, Virmani R. Sudden coronary death. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation 1995 Oct 1;92(7):1701-9.
- Thomas AC, Knapman PA, Krikler DM, Davies MJ. Community study of the causes of "natural" sudden death. BMJ 1988 Dec 3;297(6661):1453-6.
- Chugh SS, Kelly KL, Titus JL. Sudden cardiac death with apparently normal heart. Circulation 2000 Aug 8;102(6):649-54.
- Ludwig J. Handbook of Autopsy Practice. 3 ed. Towata: New Jersey; 2002.
- Bancroft J, Gamble M. Theory and Practice of Histological Techniques. 5th ed. Philadelphia: Churchill Livingstone; 2004.
- Warnes CA, Roberts WC. Sudden coronary death: comparison of patients with to those without coronary thrombus at necropsy. Am J Cardiol 1984 Dec 1;54(10):1206-11.
- Myerburg RJ, Kessler KM, Castellanos A. Sudden cardiac death. Structure, function, and time-dependence of risk. Circulation 1992;85(1 Suppl):I2-10.
- Friedman M, Manwaring JH, Rosenman RH, Donlon G, Ortega P, Grube SM. Instantaneous and sudden deaths. Clinical and pathological differentiation in coronary artery disease. JAMA 1973 Sep 10;225(11):1319-28.
- Rissanen V, Romo M, Siltanen P. Prehospital sudden death from ischaemic heart disease. A postmortem study. Br Heart J 1978;40(9):1025-33.
- Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR, Blackbourne BD, Davis JH. Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death. Circulation 1974;49(5):790-8.
- Kasthuri AS, Handa A, Niyogi M, Choudhury JC. Sudden death: a clinicopathological study. J Assoc Physicians India 2002;50:551-3.:551-3.
- Kumar V, Abbas K, Fausto N. Robbins and Cotran Pathologic Basis of Disease. 7 ed. Philadelphia: WB Saunders; 2004.
- Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med 1984 May 3;310(18):1137-40.
- Reichenbach DD, Moss NS, Meyer E. Pathology of the heart in sudden cardiac death. Am J Cardiol 1977 May 26;39(6):865-72.
- Baroldi G, Falzi G, Mariani F. Sudden coronary death. A postmortem study in 208 selected cases compared to 97 "control" subjects. Am Heart J 1979;98(1):20-31.
- Rahlf G. [The heart in the elderly. Pathology: macroscopic and light microscopy findings in the heart]. Z Kardiol 1985;74 Suppl 7:9-16.:9-16.
- Sekiguchi M, Nishino H, Nishikawa T, Morimoto S, Hiroe M. Age-associated myocardial changes in various heart diseases. A clinicopathologic analysis in biopsied and autopsied myocardium. Jpn Circ J 1986;50(10):1023-32.
- Ladich E, Virmani R, Burke A. Sudden cardiac death not related to coronary atherosclerosis. Toxicol Pathol 2006;34(1):52-7.
- Ahmad M, Afzal S, Malik IA, Mushtaq S, Mubarik A. An autopsy study of sudden cardiac death. J Pak Med Assoc 2005;55(4):149-52.
- Gall E. Autopsy Pathology - a manual and atlas. 2nd ed. Philadelphia: Saunders; 2009.
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