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42 terms

forensic pathology - natural death

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Sudden and unexpected natural death - why is toxicological analysis is necessary in all such cases?
Died "of" a particular disease vs. died "with" a particular disease
Instantaneous death
occurs within seconds of onset of symptoms
Sudden death
Death occurring within minutes of the onset of symptoms
Unexpected death
May occur in an individual with significant natural disease, but the death was not expected at that time
Most common systems involved in sudden unexpected natural death
Cardiovascular system, Respiratory system, Central nervous system
Atherosclerotic coronary artery disease (ASCAD)
Disease in blood vessels that supply the heart. Majority of sudden natural deaths investigated by medical examiner offices
Cardiomyopathy
disease of heart muscle
Histology of heart
Look for areas of cell death, scars, lack of blood flow
Atherosclerosis
Fat gets into the wall, can become calcified, can rupture, thrombosis
"Vulnerable" artery
fat is near blood flow and a clot can form
Atherosclerotic coronary artery disease - medical history
Often no history of previously diagnosed coronary disease
Initial presenting symptom in 30% of people with CAD is
sudden death
Most common finding (ASCAD)
at least one coronary artery with at least 75% stenosis. May or may not have evidence of myocardial tissue damage.
The finding of severe atherosclerotic coronary artery disease
does not rule out death due to other causes
ASCAD Mechanism of death
Cardiac arrhythmias, ventricular fibrillation
ASCAD Cause of death
Cardiac arrhythmia due to severe atherosclerotic coronary artery disease (or atherosclerotic cardiovascular disease)
ASCAD Manner of death
Natural
Aortic aneurysm
Destruction of aortic wall due to atherosclerosis
Hypertensive cardiovascular disease
Hypertrophy of muscle of heart due to increased work-load
Weight of heart in hypertension
increased above 350 gm
Finding what under microscope can add to diagnosis of hypertension?
hypertrophied nuclei
Hypertension mechanism of death
acute cardiac arrhythmia
Cardiomyopathies
Primary diseases of the heart muscle
Hypertrophic cardiomyopathy
Enlarged heart with septum thickened more than left ventricular free wall
Hypertrophic cardiomyopathy victims are often
young athletes dying suddenly during or immediately after physical exertion
Myocarditis (inflammatory cardiomyopathy)
Inflammation of the heart muscle
Most common cause of sudden respiratory death
pulmonary thromboembolism
Pulmonary thromboembolism
Clots arise from deep venous thrombosis in the lower extremities, dislodge, and travel to the pulmonary artery and into the lungs
Thrombosis may be due to blood stasis in the lower extremities
Immbolitiy, bed rest, obesity
If 60% of the pulmonary vasculature is suddenly blocked
the heart cannot pump blood through the lungs, leading to cardiovascular collapse
Saddle embolism
clot goes across right and left pulmonary artery
Pneumonia
Invasion of lung tissue by organisms (viral, bacterial)
Pneumonia autopsy findings
Lungs will have areas of consolidation
Consolidation
areas that are filled with inflammatory cells instead of air
Microscopic examination pneumonia
will show alveoli filled with inflammatory cells
Marked swelling (edema) of the epiglottis leads to
mechanical obstruction of the airway
Asthma death is caused by
obstruction of the airways by muscular constriction and mucus production such that air can get into but not out of the lung
Autopsy findings, asthma
Overinflated, billowy lungs; clear mucus plugging the bronchi
Seizure disorder
Uncoordinated abnormal electrical discharge from neurons; a disorder of function
Epilepsy
Recurrent seizure disorder
Intracerebral hemorrhage
Hemorrhagic stroke - sudden death depends on anatomic location
'Berry' aneurysm
Sudden onset of severe headache, due to congenital malformation of media of the blood vessel at points of bifurcation