34. Natural Deaths Flashcards
For what time frame is a death considered ‘sudden’?
From within an hour to 24 hours after the onset of illness
What is acute coronary syndrome?
Any group of symptoms compatible with acute myocardial ischaemia
- unstable angina
- MI with or without ST segment elevation
What are the complications associated with acute coronary syndrome?
Atheroma and thrombosis
Acute MI
Ischaemic heart disease
Arrhythmias
What size heart is a male is considered a reason for sudden death?
> 500g
What size heart in a female is considered evidence for a sudden cardiac death?
> 400g
What is a cardiomyopathy?
Heart is structurally or functionallly abnormal, in a way that is not explained by CAD, high BP, valve failure or congenital defects
What is the most common cause of sudden death?
Hypertrophic cardiomyopathy
What age group is hypertrophic cardiomyopathy present in?
30-40s
What are the signs of hypertrophic cardiomyopathy histiologically?
Interstitial fibrosis
Disorganised, branching and hypertrophic myocytes
What conditions can hypertrophic cardiomyopathy develop secondary to?
Hypertension
Amyloid
Glycogen storage disorders
Genetic syndromes
What are the types of cardiomyopathy?
Hypertrophic
Dilated
Restrictive
Arrythmogenic RV dysplasia
What are the causes of dilated cardiomyopathy?
Genetic Alcohol Drugs Viral May be end stage presentation of other types of heart disease
What is the least common type of cardiomyopathy?
Restrictive
What might restrictive cardiomyopathy be secondary to?
Lupus
Amyloid
Sarcoid
How does arrhythmogenic RV dysplasia appear histiologically?
Fibrosis and fat +/- inflammation
What can prevent fatal arrythmias in RV dysplasia?
Defibrillator
What are the causes of myocarditis?
Infection Hypersensitivity Toxic Giant cell Sarcoidosis
What does hypertensive heart disease present as?
Acute LV failure or arrhythmias
Name 2 possible valvular heart diseases
Floppy mitral valve
Aortic valve stenosis
Name a physiological cause of sudden cardiac death
Wolff-Parkinson-white syndrome
What is Wolff-Parkinson-White syndrome?
On an ECG appears as a short PR interval, showing an abnormal pathway between atria and ventricles
May develop arrythmias
Name 3 ion channelopathies
Long QT syndrome
Brugada syndrome
CPVT
What type of drug can trigger long QT syndrome?
Antipsychotics
What is the pathology of long QT syndrome?
Na+ channel mutations means it takes longer to polarise
Syncope, seizures and sudden cardiac death
What gene is mutated in long QT syndrome?
SCN5A
What is brugada syndrome?
Na+ channel mutation caused by loss of SCN5A function
Also known as unexpected natural death syndrome in southeast asia
What ion channel is affected in CPVT?
Ca++
What are the symptoms of SADS?
Abnormal heart rhythm Fast HR that comes and goes when resting Breathlessness on effort chest pain dizziness Fainting and black outs
What investigations should be done if SADS is part of the differential?
Family history
ECG and echo
Who does spontaneous coronary artery dissection most commonly happen in?
Post partum and older females
Which artery is most commonly involved in spontaneous coronary artery dissection?
LAD
What is a bridging artery?
Main coronary artery is embedded in ventricular muscle, shuts off when muscle contracts
What is the difference between SUDI and SIDS?
SUDI= Sudden Unexpected Death in Infants, describes any sudden death in a child younger than 1
SIDS means no cause has been found for SUDI after extensive investigation
What is SUDC?
Sudden Unexpected Death in Childhood
child older than one year, in their sleep
Give 2 vascular causes of SD
Aortic dissection
Rupture of aortic aneurysm
Give 4 causes of CNS SD
Epilepsy
Subarachnoid haemorrhage
Intra-cerebral haemorrhage
Any disease with associated hydrocephalus
What could a sudden death in a psych patient be caused by?
Neuroleptic malignant syndrome
What are causes for sudden respiratory death?
Epiglottitis Spontaneous pneumothorax of newborn PE Asthma, COPD, pneumonia Haemoptosis
What are causes for sudden GI death?
Inflammatory
Haematemesis
Ischaemia and infarction
Carcinoma
What are causes for sudden death within 6 weeks after pregnancy?
Haemorrhage Infection Amniotic fluid embolism Ruptured ectopic pregnancy Eclampsia
