Evaluation Of Cardiac Conduction System In Sudden Deaths

Abstract

Objective:In this study, revealing the regional characteristics of the cardiac conduction system pathologies in sudden death cases is aimed. Besides, this is the first study of Adana region forensic cases related to the cardiac conduction system pathologies. Methods:Twenty seven cases of sudden unexpected death and 4 cases with known causes of death as a control group have been included in the study. Samples from sinoatrial node and atrioventicular node were taken in total 31 cases. Samples were evaluated with light microscope after staining through histochemical staining methods. Results:There were significant pathological changes of the sinoatrial node and atrioventricular node in 10 of the cases. And in 3 of all cases (11.1%), the abnormalities of the conduction system were considered to have the possibility for causing death. Conclusion:We have concluded that it is of importance to evaluate the cardiac conduction system in sudden unexpected death cases and this topic should be kept in sight in forensic pathology.Key words: forensic pathology, cardiac conduction system, sudden death, autopsy ÖZET Amaç:Bu çalışmada, ani kardiyak ölüm vakalarında kardiyak ileti sistemi patolojilerinin bölgesel özelliklerinin ortaya konması amaçlandı. Ayrıca bu çalışma, kardiyak ileti sistemi patolojileri konusunda Adana bölgesindeki adli olgularda yapılan ilk çalış-madır. Yöntemler:Yirmi yedi ani-beklenmedik ölüm olgusu ile ölüm nedeni bilinen 4 olgu kontrol grubu olarak çalışmaya alındı. Toplam 31 olguda, sinoatrial nod ve atrioventriküler nod bölgelerinden örnekler alındı. Örnekler histokimyasal boyama yöntemleri ile boyanarak ışık mikroskobunda incelendi. Bulgular:Ani-beklenmedik ölüm olgularının 10'unda sinoatrial nod ve atrioventriküler nodda belirgin patolojik bulgular saptandı. Tüm olguların 3'ünde (%11,1), ileti sistemi anomalilerinin ölüme neden olabileceği düşünüldü. Sonuç:Ani beklenmedik ölüm olgularında kardiyak ileti sistemi değerlendirmesinin önemli olduğu ve adli patolojide bu konunun göz önünde bulundurulması gerektiği sonucuna vardık. (2,13,14,(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27) Grade I (+): Irregular widening of the myofibrils or small amounts of fibrosis, adipose tissue infiltration less than 25%, random mono nuclear cellular accumulation.Grade II (++): Small amounts of irregular fibrous tissues and irregular myofibrils, 25-50% of adipose tissue infiltration, 25-50% luminal obliteration of the arteries, accumulations of mono nuclear cellular infiltration. 2,13,28). We think that it may be a result of the differences between the regional dietary habits as well as the higher average age in our study (2,(12)(13)(14)28 (12,13,18,29 (4,13,(30)(31)(32)(33)(34) (14,21,(42)(43)(44) (2,13,16,26,27,46 271. Gordon I, Shapiro HA. Forensic Medicine, 2nd Ed., Edinburg, London, Melbourne, New York: Longman Group Limited, 1982. 2. Cohle SD, Saurez-Mier MP, Aguilera B. Sudden death resulting from lesions of the cardiac conduction system. Am J Foren Med Path 2002;23:83-9. 3. Denfield SW...

Postmortem Study of Histopathological Lesions of Heart in Cases of Sudden Death - An Incidental Findings

“…In present study males were 85.21%, while 14.78% cases were females (Figure 1). The male dominance was reported by other authors Bora Ozdemir et al 18 reported 73% male and 27% female, Ramazan Karanfil et al 19 reported 74% male and 26% female and Thomas AC, Knapman PA et al 20 reported ischemic heart disease accounted 59% of the sudden deaths in 65% men and 41% women.…”

A histopathological analysis of prevalence of various heart diseases: an autopsy study

“…Similar findings were reported by Ramazan Karanfil et al, 17-78 years and Chandrakala Joshi 41-60years. 2,4 This shows that age is a powerful risk factor for heart disease. The development of atherosclerosis increases markedly with age up to an age of about 65.…”

“…Similar findings were reported by Ramazan Karanfil et al, 75%, stavroula A et al, 77% and Chandrakala Joshi 64%. 2,4,5 Calcification was present in 34(53.3%) cases and thrombus in 4(5.3%) cases. Similarly thrombosis was reported in 4.8% cases by Bora Ozdemir et al 6 Plaque calcification is found more frequently in advanced lesions, it may also occur in small amounts in earlier lesions, which appear in 2 nd and third decade of life.…”

“…6 Ramazan et al, reported myocardial infarction in 48% cases, which is higher than our study whereas Wang HY, et al, reported ischaemic heart disease in 7% cases, which is lower than the present study. 4,7 This difference may be due to time variability between onset of ischaemia and time of death. Because microscopic features depend upon the time period between onset of ischaemia and death.…”

“…In the literature, similar incidence that is 7% was reported by Cristino Basso et al, and Wang HY et al 7,8 Ramazan Karanfil et al, and Chandrakala et al, reported a much higher incidence of cardiac hypertrophy in 66% and 52% cases respectively. 2,4 Myocarditis was found in 5 (3.5%) cases. 6,[8][9][10] In the present study pericarditis was found in 4 (2.8%) cases, whereas Chandrakala Joshi reported pericarditis in only 0.86% cases.…”