Abstract

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Sudden death is often the first and only symptom of an advanced occlusive coronary arteriosclerosis; with or without old or fresh thrombosis, with or without myocardial infarction.
Coronary Insufficiency may be precipitated by emotional or exertional stimuli which increase heart action; or the heart may suddenly stop even with complete rest because of inadequate coronary circulation.
Keywords: Sudden Natural Death, Coronary Insufficiency.

Introduction

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Death may take place with dramatic suddenness, without any prior warning and under greatest variety of circumstances- during sleep, rest, ordinary activity, labour, sexual intercourse or under emotional or physical strain.
Occasionally, even a normal heart with intact coronary circulation and myocardium may stop suddenly because of an unusual strain brought about by severe physical effort.(2)

Case Report

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1. A middle aged painter, 50 yr old was found unconscious during work. By the time he was brought to the hospital, he was declared as brought dead.
Autopsy finding:
Case 1. External finding: Dead body of a male, aged 50 years, moderately built and nourished, rigor mortis present all over the body, post mortem staining not visible. Evidence of treatment visible were 4 ECG leads over chest. No external injuries seen.
All internal organs were intact and congested. On dissection of heart, Left coronary ostia was narrowed to a pinhead size with a tissue bridge at the opening appearing as 2 pinhead sized Left coronary ostia. Weight of the heart was 290 grams.
Cause of Death: Cardiac arrest as a result of Coronary Insufficiency.

Discussion

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Sudden death may be caused by stenosis of ostia of the coronary arteries as a result of syphilitic inflammation of aorta. One or both coronary artery mouths may be completely or partially closed off with the length of artery showing little if any change. Rarely, syphilitic coronary arteritis with narrowing of lumen may cause sudden death.
Strassmann and Goldstein reported such a case and another has been observed by the authors. In this connection, it is important to point out that round cell infiltration of the adventitia and diseased intima is frequently observed in sclerotic coronary arteries. The thickening of the artery produced is usually concentric in distribution and the inflammatory cell infiltration is more intense.(3)
Rare anomalies of the coronary arteries may cause sudden death.
Thus, in this case, the deceased, who was a painter by occupation was found dead while on work.
So, exertion and physical strain could have led to coronary insufficiency which is substantiated by the pinpoint Left Coronary Ostia seen on autopsy.(1)

References

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1. Narayan Reddy, K.S; The essentials of Forensic medicine and Toxicology (25th edition) K.Suguna devi, Hyderabad, 2006.
2. Legal medicine- Pathology and Toxicology by Thomas. A. Gonzales, Morgan Vance, Milton Helpern and Charles.J.Umberger – 2nd edition. P-115-120.
3. Vincent J.M.Di Maio- Handbook of Forensic Pathology. First south Asian edition.

Source(s) of Funding

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none

Competing Interests

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none

Disclaimer

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