14.5 Sudden Unexpected Death Flashcards
What is a sudden and unexpected death?
- WHO: Death within 24 hours of the onset of symptoms
- Death within 1 hour of the onset of symptoms
- Mason: unexpected death following so rapidly from the onset of symptoms that the cause of death could not be certified with confidence by a medical practitioner familiar with the patient
Causes of sudden death
- cardiovascular
- intracranial
- pulmonary
- GI
- Genito-urinary
- Metabolic
Cardiovascular cause
Epicardium = Coronary artery issues
- Atherosclerosis (hypertensive heart disease; myocardial ischeamia and infarction)
- Myocardial bridging (Def)
- Abnormal course
- Spasm
- Dissection (aneurysm)
Myocardium
– Cardiomyopathies*
– Myocarditis*
– Hypertensive heart disease
– Congenital and genetic diseases
Endocardium = valvular diseases
– Mitral valve prolapse*
– Acute bacterial endocarditis*
– Aortic stenosis
Blood vessels = aorta AND OTHERS
– Aneurysm rupture*
– Vasculitis*
Coronary artery atherosclerosis
General
Types
Complications
General
Coronary artery atherosclerosis:
- stenosis (narrowing) or complete occlusion of one or more of the coronary aa or their branches by atheromatous plaques
= Myocardial Ischemia ➡️ sudden death
Types
- Concentric thickening
- Eccentric thickening
Complications
- plaque rupture
- hemorrhage into plaque
- erosion and ulceration
- superimposed thrombosis
Define dissection
Defect in intima with subsequent flow of blood into wall, underneath intima, formation an intramural hematoma that continues to spread in the vessel wall.
Define aneurysm
Weakening of vessel wall with subsequent thinning and dilatation
Terminal causes and mechanism of death
- ventricular mechanism is most common
- atrial mechanism less common
Slide 16
Cardiomyopathies
- The group of diseases known as cardiomyopathies constitutes a rare but important cause of sudden death in adults.
- Classification:
- Dilated
• Alcohol
. Peripartum
. Chronic myocarditis - Hypertrophic (hocm)
- Restrictive
Myocarditis
Def
Causes
Def - inflam and destruction of heart muscle
Causes - infec
Mitral valve prolapse
- blood leaking back into left atrium (regurgitation)
NB SUDEP
- Sudden unexpected death in epilepsy
Def: - Sudden, unexpected witnessed or unwitnessed, non-traumatic and non-drowning death in patients with epllepsy, with or without evidence of a seizure and excluding documented status epllepticus, where the autopsy does not reveal a toxicological or anatomical cause of death.
Risk factors:
- Age (voung adults)
- gender (men)
- Early onset of epilepsy
- poor seizure control
- multiple drug treatment
- history of generalised tonic/clonic seizures
- treatment non-compliance
- Alcohol abuse
- un-witnessed selzure
- body position (head into pillow / ground)
Intracranial lesions
- SUDEP*
- Intracranial haemorrhage (non-traumatic!)*
➡️ rupture berry aneurysm
➡️ stroke (due to eh hypertention {basal ganglia, pons, cerebellar}) - Infective causes
➡️ meningitis (TB)
➡️ encephalitis (inflam of brain tissue without meninges)
➡️ abscess - Intracranial tumours
Respiratory system causes of sudden death
Airways = “Asphyxia” (obstruction)
– Foreign objects*
– Epiglottitis
– Asthma (acute exacerbation)
Blood vessels
– Haemorrhage*
• Tuberculosis (most common in SA)
• Lung tumour
– Pulmonary embolism (seen in unnatural deaths)
Parenchyma
- Pneumonia
Pleura (not pt with trauma like stab wound)
- pneumothorax
Genito-intestinal system causes
- Rupture of enlarged viscera
- Bleeding varices
- Bleeding ulcer
- Acute pancreatitis
- Mesenteric vessel thrombosis (people on tik)
- Strangulated bowel
- Colonic tumours
- Ulcerative colitis
Genito-urinary system cause
Complications of pregnancy
- Ruptured ectopic pregnancy
- Amniotic fluid embolism
- Complications of illegal termination of pregnancy
