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Cardiac pathology in 2007 consecutive forensic autopsies
B F Waller1, M J Catellier, M A Clark
1Cardiovascular Pathology Registry, St. Vincent Hospital and Health Care Center, Nasser, Smith & Pinkerton Cardiology, Inc., Indianapolis, Indiana.
Insights
Cardiovascular disease caused 22.8% of deaths in forensic patients, with atherosclerotic coronary heart disease being most common. Myocardial bridges were unexpectedly frequent, while acute myocarditis was rare.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Autopsy Studies
Background:
- Cardiovascular diseases are a leading cause of mortality globally.
- Forensic autopsies provide valuable data on disease prevalence in specific populations.
- Understanding cardiac pathology in forensic cases is crucial for accurate cause of death determination.
Purpose of the Study:
- To evaluate the incidence and patterns of cardiovascular disease in a large cohort of forensic patients.
- To identify common and unexpected cardiac findings in this population.
- To compare the frequency of sudden cardiac death versus acute myocardial infarction in atherosclerotic coronary disease.
Main Methods:
- Retrospective analysis of autopsy data from 2007 consecutive forensic cases.
- Systematic examination of cardiovascular structures during necropsy.
- Categorization of cardiac findings into major, minor, expected, and unexpected.
Main Results:
- Cardiovascular diseases accounted for 22.8% of deaths; atherosclerotic coronary heart disease was the most prevalent (18%).
- Sudden death was three times more common than acute myocardial infarction among those with atherosclerotic coronary disease.
- Unexpected findings included a high incidence of myocardial bridges (23%), while acute myocarditis was rare (0.6%).
- Major cardiac findings were present in 32% of cases, minor findings in 40%, and only 17% had anatomically normal hearts.
Conclusions:
- Cardiovascular pathology is a significant contributor to mortality in forensic populations.
- Myocardial bridges are a common, often unexpected, finding in forensic cardiac examinations.
- Forensic necropsy reveals a high prevalence of significant cardiac pathology, even in cases not initially suspected.
Abstract:
The incidence of various types of cardiovascular disease was evaluated in 2007 consecutive forensic patients. Cardiovascular deaths accounted for 22.8% of the study patients and atherosclerotic coronary heart disease was the most common type of cardiac disease (18%). Among subjects dying of atherosclerotic coronary disease, sudden death was three times more frequent than acute myocardial infarction. Expected cardiac findings included the incidence of severe coronary atherosclerosis (21%), floppy mitral valves (5%), and congenital bicuspid aortic valves (1%). Major cardiac findings occurred in 32% and minor cardiac findings were found in 40%. Only 17% of hearts were anatomically normal. An unexpected cardiac necropsy finding included the high frequency of myocardial bridges (23%). Unexpected cardiac findings included the low incidence of acute myocarditis (0.6%) and common finding of tunneled epicardial coronary arteries ("myocardial bridges") (23%).