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Forensics > 4. Sudden death from natural causes > Flashcards

4. Sudden death from natural causes Flashcards

1
Q

In the heart (3)

A
  • ischemic heart disease
  • valvular heart disease
  • cardiomyopathies etc.
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2
Q

Explain ischemic heart disease

A
  • insufficiency of blood supply to myocardium
  • 1st case: restricted supply due to narrowed vessels
    -2nd case: increased demand due to increased muscle
  • all arteries develop atheroma over time, resulting in narrowing of the lumen
  • this is particularly significant in the coronary arteries
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3
Q

Atheroma risk factors (7)

A
  • genetic
  • diet
  • smoking
  • obesity
  • lack of exercise
  • high blood pressure
  • diabetes
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4
Q

2 main effects of moderate/severe atheroma

A
  • angina
  • sudden death
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5
Q

Angina characteristics (6)

A
  • can develop into unstable angina
  • pain at rest
  • ECG changes
  • increase in troponins
  • due to disrupted plaque
  • treated with stents and bypass
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6
Q

Sudden death from atheroma characteristics (3)

A
  • commonest cause of sudden death in western world
  • due to chronic electrical heart instability and development of sudden fatal arrhythmia
  • can develop at any time, but may be precipitated by physical exertion or stress
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7
Q

What does coronary artery thrombosis lead to? (4)

A
  • thrombus forms on the top of the atheroma
  • completely blocks the lumen
  • this leads to acute myocardial infarct
  • death of myocardium supplied by that particular coronary artery
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8
Q

Acute complications of acute myocardial infarction (4)

A
  • arrhythmias
  • cardiogenic shock
  • papillary muscle rupture
  • cardiac rupture
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9
Q

Long term complications of acute myocardial infarction (3)

A
  • chronic heart failure
  • arrhythmia
  • angina
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10
Q

Causes of cardiac enlargement (3)

A

Due to factors not to do with myocardium:
- hypertension (hypertrophy of left ventricle)
- aortic stenosis (calcification of bicuspid valve or due to bacterial endocarditis)

Due to primary abnormality of myocardium:
- cardiomyopathy: hypertrophy obstructive cardiomyopathy or dilated cardiomyopathy

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11
Q

Sudden arrhythmic/adult death syndrome (SADS) (2)

A
  • channelopathies:
  • long QT syndrome
  • Brugada syndrome
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12
Q

Aortic aneurysm death

A
  • arterial CVD cause
  • ruptured aortic aneurysm
  • aneurysms are result of severe atheroma
  • in this cause effect of atheroma is primarily weakening of the wall rather than narrowing
  • can eventually rupture and usually seen in older people
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13
Q

Embolism characteristics

A
  • venous CVD cause
  • emboli can be: thrombus, fat/bone marrow, air, amniotic fluid, blood clot
  • thrombi are formed in leg veins (travel to lungs) or in the heart (travel to brain)
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14
Q

Pulmonary embolism

A
  • starts with DVT
  • blood clot forms in the leg veins (deep calf, ilio-femoral or pelvic)
  • thrombus breaks off and embolises
  • goes to pulmonary arteries
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15
Q

Risk factors for DVT/PE

A
  • recent surgery
  • immobility
  • obesity
  • age
  • CHF
  • varicose veins
  • malignancy
  • pregnancy
  • certain oral contraceptives
  • inherited blood disorders
  • long air jurneys
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16
Q

Causes of sudden death in the lungs (2)

A
  • pneumonia
  • asthma
17
Q

Pneumonia types and characteristics (2)

A
  • Lobar pneumonia
  • largely in one lobe
  • firm and grey
  • infection via blood
  • usually in debilitated individuals
  • Bronchopneumonia
  • more general, often both lungs
  • more patchy
  • often a complication of something else (chronic lung disease, head injury, trauma etc.)
18
Q

Acute asthma death

A
  • hypersensitivity response
  • medium and small bronchi blocked by combination of plugs of mucous and spasms
  • lungs become hyper-ventilated
  • acute breathlessness and stridor
19
Q

Sudden death in the abdomen (3)

A
  • GIT haemorrhage (ulcers, varices)
  • Peritonitis (perforated ulcers, perforated large bowel diverticula, perforation in intestinal obstruction)
  • Bowel infarction (strangulated herniation, vascular disease)
20
Q

Sudden death in the brain (4)

A
  • cerebral haemorrhage
  • subarachnoid haemorrhage
  • epilepsy
  • meningitis
21
Q

Cerebral haemorrhage (4)

A
  • basal ganglia or brainstem usually
  • hypertension
  • older people
  • fairly rapid unconsciousness and often fatal
22
Q

Subarachnoid hemorrhage (4)

A
  • base of brain around brainstem
  • due to rupture of small aneurysm (berry aneurysm) from congenital weakness of the wall
  • can occur at all ages
  • not always fatal, surgery
23
Q

Meningits (5)

A

Meningococcal
- inhaling droplets
- often in previously healthy
- often rapid course of illness (less than a day)

Pneumococcal
- usually from lung infection
- more common in debilitated

24
Q

Epilepsy

A
  • due to abnormal discharge of neurons
  • death can occur during grand mal seizure
  • most deaths are from SUDEP (sudden unexpected death in epilepsy)
  • probably due to cardiac arrhythmia or apnoea
25
Q

Rapid death (3)

A
  1. coronary artery disease
  2. cardiac enlargement
  3. pulmonary thromboembolism
26
Q

Less rapid death (6)

A
  1. acute MI
  2. ruptured aortic aneurysm
  3. cerebral haemorrhage
  4. acute asthma
  5. epilepsy
  6. GIT haemorrhage

Forensics (15 decks)

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