Sudden unexpected Death

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Author:
minna528
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17480
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Sudden unexpected Death
Updated:
2010-05-03 22:22:29
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bu forensic
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Pathology lecture 10
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  1. Cardiovascular system deaths are _____% of the total unexpected natural deaths
    53%
  2. Respiratory system deaths are ____% of total unexpected natural deaths
    18%
  3. Central nervous system deaths are ___% of total unexpected natrual deaths
    12%
  4. Sudden and unexpected natural death in adults may account for up to ___% of the autospy caseload at the MEs office
    50%
  5. Is toxicology analysis required in all cases?
    yes it is! Need to determine died of a particular disease as apposed to died with a particular disease
  6. Sudden death
    • Occurs within minutes of onset of symptoms
    • often dead
  7. unexpected death
    May occur in individual with significant natural disease but the death was not expected at that time
  8. What are the three most common systems involved in sudden unexpected natural death
    • 1. cardiovascular system
    • 2. respiratory system
    • 3. central nervous system
  9. With atherosclerotic cardiovascular disease there is often _____history
    No history of previously diagnosed coronary disease
  10. in Atherosclerotic coronary artery disease symptoms may be:
    • indigestion or abdominal pain
    • back, shoulder or neck pain
    • antacid tablets commonly found at the scene
  11. ASCAD common findings
    • Most common is at least 1 coronary artery with at least 75% stenosis
    • Thrombosis in lumen of artery (less than 15%)
    • May or may not have: myocardial tissue damage- myocardial fibrosis, acute myocardial necrosis
  12. T/F The finding of severe atherosclerotic coronary artery disease rules out death due to other causes
    Faaaalse
  13. Cause of death of ASCAD
    Cause- cardiac arrhythmia due to severe atherosclerotic coronary artery disease or atherosclerotic cardiovascular disease.
  14. ASCAD mechanism of death
    • cardiac arrhythmia
    • ventricular fibrilllation
  15. Atherosclerotic disease of the aorta
    • destruction of aortic wall due to atherosclerosis
    • aorta may rupture- into body cavity or into pericardial cavity
  16. In disease of the aorta: aortic dissection findings include blood from the lumen gains access to the wall of aorta through an ____
    blood separates the layers of the aortic call for a distance
    blood may rupture out at a site________________
    intimal tear

    distant from the tear of the intimal surface
  17. Hypertensive cardiovascular disease
    Hypertrophy of muscle of heart due to increased work-load
  18. Hypertensive cardiovascular disease usually accompanied by:
    atherosclerotic coronary artery disease
  19. In hypertensive cardiovascular disease the weight of the heart is increased above ____
    350gm
  20. In hypertensive cardiovascular disease:
    • myocytes may have enlarged nuclei
    • may be associated changes in the kidney
  21. The mechanism of death for hypertensive cardiovascular disease:
    acute cardiac arrhythmia
  22. What is the primary disease of the heart muscle?
    • cardiomyopathies:
    • hypertrophic cardiomyopathy
    • myocarditis
  23. Hypertrophic cardiomyopathy/asymmetric septal hypertrophy
    Enlarged heart with septrum thickness more than left ventricular free wall
  24. Histology of hypertrophic cardiomyopathy often shows:
    Disarray and haphazard arrangemtn of myoctes in the septum
  25. Victims of hypertrophic cardiomyopathy are often_______ dying suddenly during or immediately after______
    young athletes


    physical exertion
  26. T/F 50% of cases of hypertrophic cardiomyopathy may be attributed to a genetic defect
    True
  27. Myocarditis
    • inflammation of the heart
    • often viral
    • may have history of flu-like symptoms
  28. Myocarditis microscopic exam reveals:
    inflammatory cells and myocyte necrosis
  29. What is the most common form of sudden respiratory death?
    Pulmonary thromboembolism
  30. Pulmonary thromboembolism
    Clots arise from deep venous thrombosis in lower extremities, dislodge and travel to pulmonary artery and into the lungs
  31. Thrombosis may be due to blood stasis in the lower extremities due to:
    immobility, bed rest, obesity
  32. If ____% of the pulmonary vasculature is suddenly blocked, the heart can not pump blood through the lungs leading to _____
    60%

    cardiovascular collapse
  33. Pneumonia
    • Invasion of lung tissue by oraganism ( viral, bacteria)
    • usally an underlying disorder (trauma-brain injury, alcohol or drug use)
    • Signs/symptoms may have been ignored or treated with over the counter products
  34. Autopsy findings of pneumonia
    • lung has areas of consolidation (areas filled with inflammatory cells instead of air)
    • microscopic exam: aveoli filled with inflammatory cells
  35. Epiglottitis
    • Bacterial of viral inflammation of epiglottis
    • marked welling (edema) of epiglottis leads to mechanical obstruction of the airway
    • rapid death
    • Immediate intubation of tracheostomy is required
  36. Asthma
    • may present at status asthaticus or sudden collapse
    • exposure to allergen
    • Obstruction of airways by muscular constriction and mucus production such that air can get into but not out of the lung
  37. Autopsy findings in asthma
    • over inflated, billowy lungs
    • clear mucus plugging the bronchi
  38. Microscopic analysis of asthma
    • increased muscle in walls of airways
    • increased mucus producing cells
    • mucus in lumen
  39. Seizure disorder
    uncoordinated abnormal electrical discharge from neurons; disorder of function
  40. Seizure disorder is analogous to:
    cardiac arrhthmia
  41. Epilepsy
    recurrent seizure disorder
  42. Mechanism of death in seizure disorder
    Cardiac arrhythmia
  43. Idiopathic epilepsy
    • brain appears normal in autopsy
    • maner of death natural
  44. Post traumatic epilepsy
    • abnorma discharge starts in area of injury
    • manner of death is accident or homicide
  45. Bite marks on tongue found in less that ___% of seizure deaths
    25%
  46. Toxicology results for seizure deaths often find
    Subtherapeutic levels of anticonvulsant medication
  47. Ruptured blood vessels of brain cause:
    subarachnoid hemorrhage
  48. Vascular malformation-congenital
    • tangle of small arteries and veins
    • may cause headache or seizure disorder
  49. Berry aneurysm
    • sudden onset of severe headache (worst headache i've ever had)
    • sudden collapse
  50. Berry aneurysm due to
    • Congenital malformation of media of blood vessel at points of bifurcation
    • -vessels at base of brain (circle of willis)
    • causes subarachnoid hemorrhage at base of the brain
  51. Berry aneurysm may be associated with:
    • Episodes of increased blood pressure
    • -drugs, emotional, hypertension
    • straining
    • physical activity

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