Investigative protocole of sudden cardiac death in young adults

Abstract

Investigative protocole of sudden cardiac death in young adults. The authors present some recent theories in sudden cardiac death, SCD, diagnosis: clinical markers (ex. troponin, brain natriuretic petide, BNP, etc.), apoptosis markers and genetic diagnosis, cardiac conducting techniques, etc. A protocol for a complete diagnosis is revised. We studied 40 autopsies cases of sudden death from the casuistry of the National Institute of Legal Medicine Mina Minovici Bucharest in 2006. We selected 24 autopsy reports with cause of death statements related to cardiovascular diseases: myocardial infarction, dishrytmias, toxic cardiomyopathies (alcohol and other drugs of abuse such as cocaine, heroine), etc. Atherosclerosis was founding 13 cases, extensive fibrosis in 22 cases (interstitial, subendocardic, subepicardial), perivascular fibrosis in 24 cases, fat infiltration in 20 cases, stasis in 18 cases, hypoxia in 23 cases and bridging in 4. Most parameter were graded from 0 (absent) to 1 (mild), 2 (moderate), 3 (severe) and statistically correlated with both SPSS data analyze program and Statistical Functions Microsoft Excel 2007, Windows Vista Business; we used t-Student test, p value, Pearson index. Van Gieson and HE were used for histopathological study. We noticed very frequently perivascular fibrosis as much as extensive myocardial fibrosis especially in toxic cases. A frequent association statistically relevant was found between interstitium / subendocardium / subepicardium and perivascular fibrosis (r = 0,36) most probably hypoxia induced. A positive correlation was found between necroptic findings and histopathology, showing that whenever present SCD necroptic findings are relevant for forensic pathology diagnosis (r=0,42). A strong correlation was found also between interstitial fibrosis and fat myocardial infiltration (r = 0,68). However we did not prove statistical correlations between atherosclerosis and interstitial firbrosis or fat infiltration, these parameters proved to be independent in our study. Light mycroscopy is mandatory in SCD diagnosis but more often investigation must be enlarged with chemistry (seric and tisular), immune histochemistry and cardiac conduction system study.