34. Natural Deaths

Question 1

For what time frame is a death considered ‘sudden’?

Answer 1

From within an hour to 24 hours after the onset of illness

Question 2

What is acute coronary syndrome?

Answer 2

Any group of symptoms compatible with acute myocardial ischaemia

• unstable angina
• MI with or without ST segment elevation

Question 3

What are the complications associated with acute coronary syndrome?

Answer 3

Atheroma and thrombosis
Acute MI
Ischaemic heart disease
Arrhythmias

Question 4

What size heart is a male is considered a reason for sudden death?

Answer 4

> 500g

Question 5

What size heart in a female is considered evidence for a sudden cardiac death?

Answer 5

> 400g

Question 6

What is a cardiomyopathy?

Answer 6

Heart is structurally or functionallly abnormal, in a way that is not explained by CAD, high BP, valve failure or congenital defects

Question 7

What is the most common cause of sudden death?

Answer 7

Hypertrophic cardiomyopathy

Question 8

What age group is hypertrophic cardiomyopathy present in?

Answer 8

30-40s

Question 9

What are the signs of hypertrophic cardiomyopathy histiologically?

Answer 9

Interstitial fibrosis

Disorganised, branching and hypertrophic myocytes

Question 10

What conditions can hypertrophic cardiomyopathy develop secondary to?

Answer 10

Hypertension
Amyloid
Glycogen storage disorders
Genetic syndromes

Question 11

What are the types of cardiomyopathy?

Answer 11

Hypertrophic
Dilated
Restrictive
Arrythmogenic RV dysplasia

Question 12

What are the causes of dilated cardiomyopathy?

Answer 12

Genetic
Alcohol
Drugs
Viral
May be end stage presentation of other types of heart disease

Question 13

What is the least common type of cardiomyopathy?

Answer 13

Restrictive

Question 14

What might restrictive cardiomyopathy be secondary to?

Answer 14

Lupus
Amyloid
Sarcoid

Question 15

How does arrhythmogenic RV dysplasia appear histiologically?

Answer 15

Fibrosis and fat +/- inflammation

Question 16

What can prevent fatal arrythmias in RV dysplasia?

Answer 16

Defibrillator

Question 17

What are the causes of myocarditis?

Answer 17

Infection
Hypersensitivity
Toxic
Giant cell
Sarcoidosis

Question 18

What does hypertensive heart disease present as?

Answer 18

Acute LV failure or arrhythmias

Question 19

Name 2 possible valvular heart diseases

Answer 19

Floppy mitral valve

Aortic valve stenosis

Question 20

Name a physiological cause of sudden cardiac death

Answer 20

Wolff-Parkinson-white syndrome

Question 21

What is Wolff-Parkinson-White syndrome?

Answer 21

On an ECG appears as a short PR interval, showing an abnormal pathway between atria and ventricles
May develop arrythmias

Question 22

Name 3 ion channelopathies

Answer 22

Long QT syndrome
Brugada syndrome
CPVT

Question 23

What type of drug can trigger long QT syndrome?

Answer 23

Antipsychotics

Question 24

What is the pathology of long QT syndrome?

Answer 24

Na+ channel mutations means it takes longer to polarise

Syncope, seizures and sudden cardiac death

Question 25

What gene is mutated in long QT syndrome?

Answer 25

SCN5A

Question 26

What is brugada syndrome?

Answer 26

Na+ channel mutation caused by loss of SCN5A function | Also known as unexpected natural death syndrome in southeast asia

Question 27

What ion channel is affected in CPVT?

Answer 27

Ca++

Question 28

What are the symptoms of SADS?

Answer 28

``` Abnormal heart rhythm Fast HR that comes and goes when resting Breathlessness on effort chest pain dizziness Fainting and black outs ```

Question 29

What investigations should be done if SADS is part of the differential?

Answer 29

Family history | ECG and echo

Question 30

Who does spontaneous coronary artery dissection most commonly happen in?

Answer 30

Post partum and older females

Question 31

Which artery is most commonly involved in spontaneous coronary artery dissection?

Answer 31

LAD

Question 32

What is a bridging artery?

Answer 32

Main coronary artery is embedded in ventricular muscle, shuts off when muscle contracts

Question 33

What is the difference between SUDI and SIDS?

Answer 33

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

Question 34

What is SUDC?

Answer 34

Sudden Unexpected Death in Childhood | child older than one year, in their sleep

Question 35

Give 2 vascular causes of SD

Answer 35

Aortic dissection | Rupture of aortic aneurysm

Question 36

Give 4 causes of CNS SD

Answer 36

Epilepsy Subarachnoid haemorrhage Intra-cerebral haemorrhage Any disease with associated hydrocephalus

Question 37

What could a sudden death in a psych patient be caused by?

Answer 37

Neuroleptic malignant syndrome

Question 38

What are causes for sudden respiratory death?

Answer 38

``` Epiglottitis Spontaneous pneumothorax of newborn PE Asthma, COPD, pneumonia Haemoptosis ```

Question 39

What are causes for sudden GI death?

Answer 39

Inflammatory Haematemesis Ischaemia and infarction Carcinoma

Question 40

What are causes for sudden death within 6 weeks after pregnancy?

Answer 40

``` Haemorrhage Infection Amniotic fluid embolism Ruptured ectopic pregnancy Eclampsia ```