Case Report

By Dr. Asma Kausar
Corresponding Author Dr. Asma Kausar
Forensic Medicine, St.John`s Medical College, Bangalore, E-27,St.John`s staff quarters - India
Submitting Author Dr. Asma Kausar

Sudden Natural Death, Coronary Insufficiency

Kausar A. Sudden Natural Death due to Coronary Insufficiency - A Case Report. WebmedCentral FORENSIC MEDICINE 2011;2(12):WMC002560
doi: 10.9754/journal.wmc.2011.002560
Submitted on: 02 Dec 2011 07:44:26 PM GMT
Published on: 03 Dec 2011 08:06:25 PM GMT


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.


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

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.


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)


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


Competing Interests



This article has been downloaded from WebmedCentral. With our unique author driven post publication peer review, contents posted on this web portal do not undergo any prepublication peer or editorial review. It is completely the responsibility of the authors to ensure not only scientific and ethical standards of the manuscript but also its grammatical accuracy. Authors must ensure that they obtain all the necessary permissions before submitting any information that requires obtaining a consent or approval from a third party. Authors should also ensure not to submit any information which they do not have the copyright of or of which they have transferred the copyrights to a third party.
Contents on WebmedCentral are purely for biomedical researchers and scientists. They are not meant to cater to the needs of an individual patient. The web portal or any content(s) therein is neither designed to support, nor replace, the relationship that exists between a patient/site visitor and his/her physician. Your use of the WebmedCentral site and its contents is entirely at your own risk. We do not take any responsibility for any harm that you may suffer or inflict on a third person by following the contents of this website.

4 reviews posted so far

Death Due to Coronary Insufficiency
Posted by Dr. William J Maloney on 11 Feb 2014 02:54:16 PM GMT Reviewed by Interested Peers

Sudden death
Posted by Dr. Raghavendra B YP on 02 Jan 2012 10:45:00 AM GMT

0 comments posted so far

Please use this functionality to flag objectionable, inappropriate, inaccurate, and offensive content to WebmedCentral Team and the authors.


Author Comments
0 comments posted so far


What is article Popularity?

Article popularity is calculated by considering the scores: age of the article
Popularity = (P - 1) / (T + 2)^1.5
P : points is the sum of individual scores, which includes article Views, Downloads, Reviews, Comments and their weightage

Scores   Weightage
Views Points X 1
Download Points X 2
Comment Points X 5
Review Points X 10
Points= sum(Views Points + Download Points + Comment Points + Review Points)
T : time since submission in hours.
P is subtracted by 1 to negate submitter's vote.
Age factor is (time since submission in hours plus two) to the power of 1.5.factor.

How Article Quality Works?

For each article Authors/Readers, Reviewers and WMC Editors can review/rate the articles. These ratings are used to determine Feedback Scores.

In most cases, article receive ratings in the range of 0 to 10. We calculate average of all the ratings and consider it as article quality.

Quality=Average(Authors/Readers Ratings + Reviewers Ratings + WMC Editor Ratings)