SUDDEN NATURAL DEATH IN AN UNUSUAL SETTING FOLLOWING RUPTURE OF LEFT VENTRICULAR WALL

Dr. Sunil*, Dr. Sunil Kumar Duchania, Dr. Vivek Kumar Chouksey and Dr. Yashoda Rani

ABSTRACT

Objectives: Cardiac rupture as a complication of Acute myocardial infarction (AMI) has been described as occurring infrequently. In patients with AMI, left ventricular free wall rupture is an infrequent complication (2–4%) but it is associated with a high mortality from pericardial tamponade. It accounts for 5–24% of all in hospital deaths related to AMI. In all such cases with findings of cardiac rupture at autopsy, the forensic pathologist after meticulous autopsy, consider the relative significance of disease, trauma and toxicological findings when determining the cause of death. This requires a consideration of evidence beyond the autopsy including the history, scene and ancillary investigations. Methods: Heart retrieved and dissected along the great vessels by input output methods. Results: A case of an unknown about 40 year-old man who was found lying unconscious in a suspicious and isolated place who had findings of ventricular wall rupture complicated by pericardial tamponade. Anterior wall of left ventricle was found ruptured which is of size 3x0.5 cm through and through, 2cm above the apex. On further exploration, arterial walls were found to be thickened. Left anterior descending artery, right coronary artery and left circumflex showed about 80%, 70 % and 60% luminal narrowing respectively. There was slight increase in thickness of left ventricular wall that measured 1.2 cm whereas the right ventricular wall was 0.3 cm thick. Conclusions: The paper stresses the importance of meticulous autopsy in cases of cardiac rupture in unidentified individuals recovered from suspicious and isolated places with no antecedent history or previous treatment record of any heart related ailment such as myocardial infarct and differentiate sudden death from accidental or homicidal deaths in such cases.

Keywords: Post Myocardial Infarction, Ruptured Ventricle, Cardiac tamponade.