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Sudden death due to unsuspected coronary vasculitis
C I Swalwell1, S K Reddy, V J Rao
1Office of the Medical Examiner, San Diego, CA 92123.
The American Journal of Forensic Medicine and Pathology
|December 1, 1991
Summary
Sudden cardiac death can result from coronary artery vasculitis, a rare condition affecting major coronary arteries. This study highlights three cases of young to middle-aged men who experienced fatal myocardial ischemia due to this vasculitis.
Area of Science:
- Cardiovascular Pathology
- Rheumatology
- Forensic Medicine
Background:
- Coronary artery vasculitis is a known complication of systemic vasculitis, particularly polyarteritis nodosa.
- While systemic vasculitis can affect coronary arteries, severe involvement of major epicardial vessels leading to myocardial infarction is infrequent.
- Isolated coronary arteritis, without other systemic manifestations, is exceptionally rare.
Observation:
- This report details three cases of sudden, unexpected death in previously healthy young to middle-aged men.
- All decedents presented with symptoms of chest pain and shortness of breath preceding their deaths.
- Autopsies revealed arteritis of the major coronary arteries as the cause of myocardial ischemia.
Findings:
- The primary finding is the association of arteritis in major coronary arteries with sudden cardiac death.
- Myocardial infarction secondary to coronary artery vasculitis was confirmed in all three cases.
- Differential diagnoses were considered and ruled out during the autopsy process.
Implications:
- These cases underscore the importance of considering coronary artery vasculitis in the differential diagnosis of sudden cardiac death, especially in younger individuals.
- Recognition of this rare condition is crucial for medical examiners due to the unexpected nature of these fatalities.
- An approach to diagnosing isolated coronary arteritis is discussed to aid in future identification and management.