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Suspiciuos But Sudden Cardiovascular Deaths

Medrech

ISSN No. 2394-3971

Original Research Article


SUSPICIUOS BUT SUDDEN CARDIOVASCULAR DEATHS
Nnoli Martin A., Chukwuegbo Cornelius, Jegede Olushola, Nwabuko Collins.

University of Calabar/Teaching hospital Calabar.


Calabar. Cross-River State.
Nigeria.

Abstract:
Aim: To determine the causes of sudden deaths while asleep and in motion (activity).
Materials & Method: Two cases of middle aged male Negroid adults were autopsied and
analyzed in the department of anatomic pathology for the cause of sudden death at rest and in
activity-while eating.
Results: They were both found to be class 1(one) and 3(three) obsessed with estimated BMIs of
43.5kg/m2 and 50.6kg/m2 respectively. The major features were on the cardiovascular as both
had a massive cardiomegaly of 900 gm/500gms respectively. ( Normal for normal adult male of
75kg weight:300-350gms). This feature was compromised with other lesions like florid
arteriomatous plaques.
Conclusion: We found to our opinion that both died of hypertensive cardiovascular diseases
following long standing hypertension though with good management but lack of compliance on
the patients side.
Keywords: Suspected poisoned, cardiovascular death, autopsy.
Introduction:
deaths as they noted that most death peaks
In USA, Cardiovascular disease appears to
up at 7am and 9 am respectively. They
be common cause of deaths; as it is a major
further found that most deaths from
cause of deaths of men within the ages of
cardiovascular ailment peaks up to 70 %
20-65 years. Zipes and wallen ( 1988),
during the day than at night (rest periods).2
found that 80% of patients that died of
Deaths resulting from cardiovascular causes
sudden cardiac deaths are mainly due to
are often natural and unexpected as the
diseases of coronary artery like in built
occur within 60minutes of onset of final
arteriomatous plaques narrowing the
symptoms.3 At times, there will be need for
1
lumen. Willich et al 1987, attributed this
a
detailed
forensic
autopsy
with
deaths to circadian variation in the time of
toxicological analysis especially like in our
Nnoli M.A. et al., Med. Res. Chron., 2015, 3 (1), 59-63

Medico Research Chronicles, 2016

Submitted on: January 2016


Accepted on: February 2016
For Correspondence
Email ID:

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Suspiciuos But Sudden Cardiovascular Deaths

Case fatality rates following coronary events


also increases with antecendent heart rate
and fraction of coronary deaths as sudden
death increases strikingly with heart rate in
men 35-64 years of age.7 These days
clinicians assessed patients on individuals
total burden of risk than on the level of
particular risk factor.8-14 This is to the fact
that arteriosclerotic cardiovascular disease
often times are associated with many risk
factors that results to sudden deaths. This is
sequel to those risk factors producing a total
risk which clinician should have been able
to estimate in any cardiovascular disease.
Summary of Cases:
Case A: This is class 1 obese, middle aged
Negroid race of 55 years of age, an estate
developer who was found dead while
resting. An inquest was requested by his
family members because they suspected he
could have been poisoned by people around
him before he decided to take a short rest.
Case B: This is class 3 obese (estimated
BMI= 43.5kg/m2) fairly elderly Negroid
race of 63 years academician. He was said to
have died while eating but had
cardiovascular accidents (stroke) a few
months ago though fully recovered.

Figure 1: Depicts A section of abdominal aorta with Shinny areas of fatty flakes and
arteriomatous plaques with distinct obliteration of vessel lumen with various sizes.

Nnoli M.A. et al., Med. Res. Chron., 2015, 3 (1), 59-63

Medico Research Chronicles, 2016

cases where one is an estate developerchances of toxins from sites of building


ranging from asbestos and other obnoxious
materials. The toxicology could have
excluded toxic causes of sudden deaths like
occupational
or
drug
related
as
amphetamine, cocaine or anabolic steroids
abuse.4
Vincent Dimaio 1993 found that 13.4% of
deaths in such patients are due to acute
thrombosis. He further elucidated this from
outcome of autopsy cases of left coronary
and its branches showing much higher
incidence in thrombosis in comparison to the
right coronary vessel.5
However, this is hidden in hypertensive
cardiovascular disease due to plaque
formation which results to thickening of the
walls by arteriosclerotic deposits. In later
life, the vessels are noted to be more rigid
with patent lumen though calcified. This is
probably due to deposit of calcium in the
vascular walls. At times epicardial coronary
vessels may not be occluded but
examination under the microscope of
sections of myocardium will show severe
occlusive dysplasia of coronary vessles.6

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Suspiciuos But Sudden Cardiovascular Deaths

Figure 3: Depicts a section of heart with enlarged chambers, concentric hypertrophy and focal
areas of hemorrhages.
Autopsy Findings: Case A: The finding was
of class 1 obese Negroid middle aged man
with displaced apical heart and massive

cardiomegaly (Heart weighed 900gms)


Normal: 300-350gms. Section of heart
showed left ventricular hypertrophy

Nnoli M.A. et al., Med. Res. Chron., 2015, 3 (1), 59-63

Medico Research Chronicles, 2016

Figure 2: Depicts a massive cardiomegaly weighing 900g with areas of bulging epicardial fat on
the anterior wall.

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evidenced by left ventricular wall thickness


of 2cm (Normal 1-1.5cm). Multiple foci of
rheumatic
vavulitis
with
massive
arteriomatous plaques-aorta, basilar artery.
The lungs had extensive bilateral severe
pleural adhesion/pulmonary oedema; with
fatty liver change. Other systems/organs
showed no pathological changes.
Case B: The finding was of class 3obese
elderly man with estimated BMI
43.5kg/m2. The cardiovascular showed
enlarged heart of 500 gm with left
ventricular hypertrophy and massive areas
of healed rheumatic valvulitis and
hemorrhages (clots). There is still massive
arteriomatous plaques- aorta, basilar artery.
Both kidneys showed multiple foci of healed
scars evidence of chronic pyelonephritis.
There is mild to moderate anemia in
virtually all organs with mild fatty change of
the liver. Also seen is mild to moderate
cerebral oedema.
Limitations: Toxicology analysis could have
been vital as to allay the fears of his
relatives who were suspecting food and to
exclude use of drugs like cannabis,
amphetamine or industrial pollutions as in
the case of the estate developer. However,
we are constrained by unavailability of the
gas chromatography and mass spectrometer
for the analysis of such samples as gastric
contents, bile fluids or vitreous humor.
Discussions: In both Cases we concluded in
our own opinion that the cause of death was
due to hypertensive cardiovascular diseases
following
long
standing
systemic
hypertension that is being poorly managed
by the two patients despite adequate
medication from experts-cardiologists. It is
not surprisingly as most if not all in this
status of management often time comedown
with sudden death as in both cases.
In Kragol AH ( 1988) studies, they found
that most of these cardiac related deaths are
due to left ventricular hypertrophy and
minimal coronary atherosclerosis that

resulted to the sudden deaths.7 It is known


clinically that such patients with left
ventricular hypertrophy often have more
ventricular premature contractions than
without left ventricular hypertrophy or
normal people.15-17 These could have been
the factor in our own case as both not only
having
features
of
hypertensive
cardiovascular
disease
and
massive
arteriomatous plaques but with left
ventricular hypertrophy.
However, in all of the cases we had the
major issue of ignorance to seek an expert
management from both patients. Even where
the expert treatment was given there was
lack of compliance. It is also pertinent to
mention at the instances of the patients
visiting the cardiologist, the physicians
should have identified all asymptomatic
patients at high risk of sudden death as to
prevent any disease symptoms. That is
having measures of use of anti-arrhythmic
agents or even cardioverter defibrillator
implants; and to go further liaising with a
forensic pathologist as to identify the
incidence, causes and circumstances that
surrounds any cardiac related sudden deaths
the physicians must have managed.18
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