Infectious myocarditis is a common condition which often passes unrecognized, and the true incidence is thus unknown. Lymphocytic myocarditis has been recorded in 1.06% of 12,747 unselected routine autopsies performed over a 10-year period. Dilated cardiomyopathy (DCM) has an estimated frequency of 7.5-10% per 100,000 inhabitants per year. Overall, the enteroviruses, and particularly the Coxsackie-B viruses, predominate among viruses as the cause of myocarditis. As new molecular biological techniques have become available, the cytomegaloviruses (CMV) seem to have emerged as a more common cause of myocarditis than was previously recognized. Among the bacterial myocarditides, diphtheric myocarditis has become a serious threat in Russia and adjacent states during the 1990s. Among newly identified bacteria, Borrelia burgdorferi infection is accompanied by cardiac involvement in 1-8% of cases, where myocarditis with conduction disturbances is the most prominent feature. Chlamydia pneumoniae may be associated with myocarditis and sudden unexpected death. In AIDS, myocarditis with variable aetiology occurs in up to 50% of patients, although asymptomatic in most cases. In lymphocytic myocarditis and DCM, enteroviral-specific nucleotide sequences have been detected in about 30% of patients, and CMV-specific nucleotide sequences in 14%. Borrelia burgdorferi may occasionally be implicated in DCM. In this contribution we focus also on sudden unexpected death (SUD) in young athletes, since, in Sweden, an increased frequency of SUD has recently been observed in young orienteers and myocarditis was a common feature.
To confirm the hypothesis that psychotropic drugs, especially neuroleptics, lithium, and antidepressants, are implicated as a cause of unexpected sudden death in psychiatric patients because of their cardiotoxicity, especially when hidden cardiac lesions are present.
We performed a full pathological examination of 14 psychiatric patients who unexpectedly and suddenly died between 1980 and 1999.
Neuroleptics were involved in 13 instances, antidepressants in 9, and anxiolytics in 5. Psychotropic drugs were combined in all but a single patient. In all 14 patients, toxicological analyses discarded drug overdose as cause of death. At postmortem examination, the brain and abdominal organs were normal. In 13 patients, the following lesions were found in the heart and lungs: dilated cardiomyopathy (6 patients), left ventricular hypertrophy (2 patients, 1 of which was associated with mitral prolapse and anomalies of His bundle), arrhythmogenic cardiopathy of the right ventricle (1 patient), pericarditis (1 patient), mitral prolapse (1 patient), muscular bridge on the anterior interventricular artery (1 patient), and Mendelsons syndrome (1 patient). In 1 case, no changes were seen. Most of the drugs that were taken immediately prior to death can induce arrhythmias either by prolonging the QT interval, potentially resulting in torsades de pointes, or by widening QRS complexes, possibly leading to reentry and ventricular fibrillation.
Our findings suggest that the arrhythmogenic effects of psychotropic drugs can be exacer bated when preexisting hidden cardiac lesions are present and can result in sudden death. Patients should be systematically evaluated for cardiac lesions prior to starting any treatment with psychotropic drugs; the minimal effective dosage should be used.
The authors studied autopsy protocols, microscopic and histochemical data on the heart for miners who had died suddenly. No positive trend in the sudden coronary death incidence in miners was reported. A great number of sudden deaths were registered in mines. The deaths are attributed to severe atherosclerosis responsible for irreversible changes in the myocardium, coronary vascular spasms, emergence of pathological agitation triggering lethal ischemia.
Sudden cardiac death (SCD) is one of the leading manifestations of coronary heart disease in early middle age. Platelet glycoprotein (GP) Ib-IX-V receptor complexes play a key role in the initial adhesion of platelets to collagen during the formation of a coronary thrombus. The HPA-2 (Thr145 Met) and VNTR polymorphisms of the gene for GP Ibalpha have been studied previously in hospitalized patients with acute coronary syndromes. The significance of these polymorphisms in victims of sudden cardiac death is not known.
The association of these 2 polymorphisms with coronary atherosclerosis, coronary artery stenosis, coronary thrombosis, myocardial infarction (MI), and SCD was studied in the Helsinki Sudden Death Study, which comprised 2 large autopsy series, collected 10 years apart during 1981 to 1982 and 1991 to 1992, of 700 middle-aged white Finnish men who suffered sudden or violent out-of-hospital death. The 2 polymorphisms showed an almost complete linkage disequilibrium. Men with acute MI (n=80) and coronary thrombosis (n=65) were more likely to be carriers of the HPA-2 Met allele (OR 2.0 and 2.6, respectively, P
Preparticipation screening programs have been suggested to reduce the numbers of sports-related sudden cardiac deaths (SrSCD).
The purpose of this study was to identify and characterize all SrSCD aged 12-49 years and to address the difference in incidence rates between competitive and noncompetitive athletes.
All deaths among persons aged 12-49 years from 2007-2009 were included. Death certificates were reviewed. History of previous admissions to hospital was assessed, and discharge summaries and autopsy reports were read. Sudden cardiac deaths (SCDs) and SrSCD cases were identified.
In the 3-year period, there were 881 SCDs, of which we identified 44 SrSCD. In noncompetitive athletes aged 12-35 years, the incidence rate of SrSCD was 0.43 (95% confidence interval [CI] 0.16-0.94) per 100,000 athlete person-years vs 2.95 (95% CI 1.95-4.30) in noncompetitive athletes aged 36-49 years. In competitive athletes, the incidence rate of SrSCD was 0.47 (95% CI 0.10-1.14) and 6.64 (95% CI 2.86-13.1) per 100,000 athlete person-years in those aged 12-35 years and 36-49 years, respectively. The incidence rate of SCD in the general population was 10.7 (95% CI 10.0-11.5) per 100.000 person-years.
The incidence rates of SrSCD in noncompetitive and competitive athletes are not different. The study showed an increase in the incidence rate of SrSCD in persons aged 36-49 years in both noncompetitive and competitive athletes compared to those aged 12-35 years. Importantly, SCD in the general population is much more prevalent than is SrSCD in all age groups.
To provide data on the risk factors and characteristics of subjects who experience sudden cardiac death (SCD) during physical exercise.
We assessed the characteristics and the medico-legal autopsy findings of SCD victims who had experienced a witnessed fatal cardiac arrest at rest (n = 876) or in relation to physical exercise (n = 328) in the Finnish Study of Genotype and Phenotype Characteristics of SCD (FinGesture). A total of 876 (73%) witnessed SCDs occurred at rest (R group) and 328 (27%) during or immediately after physical exercise (PE group). Male gender was more common in the PE group compared to the R group (309/328, 94% versus 678/876, 77%, P
The objective of the present study was the retrospective analysis of the materials collected by the Republican Bureau of Forensic Medical Expertise, Ministry of Health and Social Development of Chuvash Republic, during the period from 1997 till 2002 for the elucidation of the chronological patterns of sudden cardiac death (SCD) associated with alcohol consumption depending on the sex and age of the victims, days of the week and months of the year as well as weather conditions. It was shown that the peak of mortality among men and women taking no alcohol fell on Monday. It was highest in May and decreased by February. The alcohol consumption significantly changes the chronological patterns of mortality from cardiovascular pathology. It was highest among the women abusing alcohol in August and October. The study has demonstrated a weak negative correlation between the frequency of sudden cardiac death among non-consumers of alcohol and dew-point temperature among the persons having alcohol in blood.
Atherosclerosis is considered to be a chronic inflammatory disease. Toll-like receptor 4 (TLR-4), a key mediator in activating inflammatory cascade, has an A-to-G functional polymorphism that changes aspartic acid to glycine at position 299. TLR-4 is activated by, for example, lipopolysaccharides. The purpose of this study was to investigate the role of a common Asp299Gly polymorphism of the TLR-4 gene in atherosclerosis.
The study comprised autopsy material from 657 men (the Helsinki Sudden Death Study; mean age 53, range 33-70 years).
Fewer G-allele carriers had 3-vessel coronary artery disease compared with AA homozygotes (OR 0.32; 95 % CI, 0.12-0.88, p = 0.027), and they also had a lower mean value for maximal coronary stenosis (p = 0.019). TLR-4 polymorphism was not significantly associated with the occurrence of acute or old myocardial infarction (MI).
The G allele of the TLR-4 gene, which is associated with a lower inflammation response, was associated with a lower risk of coronary stenosis but not with the occurrence of MI and hence is not a major factor in the development of coronary atherosclerosis.