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Ischemic and non-ischemic myocardial injuries at autopsy- an overview for forensic pathologists
Katarzyna Michaud1, Cristina Basso2, Hans H de Boer3
1University Center of Legal Medicine Lausanne - Geneva, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland. katarzyna.michaud@chuv.ch.
Insights
Myocardial injuries can result from ischemia or other factors, impacting both natural and non-natural deaths. Forensic pathologists must differentiate these causes to accurately determine the mechanism of death.
Area of Science:
- Forensic Pathology
- Cardiovascular Pathology
- Toxicology
Background:
- Cardiovascular diseases are leading causes of death globally, with ischemic heart disease (myocardial infarction) being a primary concern.
- Myocardial injury, indicated by elevated cardiac troponins, is not exclusively caused by ischemia.
- Non-ischemic myocardial damage can arise from infections, immune disorders, toxins, trauma, and other factors.
Purpose of the Study:
- To review the spectrum of ischemic and non-ischemic myocardial injuries in forensic pathology.
- To highlight the importance of differentiating myocardial injury types in natural and violent deaths.
- To propose a diagnostic approach for myocardial injuries in medico-legal investigations.
Main Methods:
- Review of scientific literature on myocardial injuries.
- Analysis of clinical and forensic case studies.
- Discussion of diagnostic markers for myocardial damage.
Main Results:
- Myocardial injury is observed in both ischemic and non-ischemic conditions.
- Elevated cardiac troponins are indicative of myocardial damage in various non-ischemic scenarios.
- Distinguishing between ischemic and non-ischemic myocardial death is crucial for determining cause of death in natural and violent fatalities.
Conclusions:
- Forensic pathologists must consider both ischemic and non-ischemic causes of myocardial injury.
- Accurate differentiation aids in complex medico-legal investigations and determining the cause of death.
- A structured diagnostic approach is essential for evaluating myocardial injuries in forensic autopsies.
Abstract:
Cardiovascular diseases are major causes of morbidity and death worldwide, and most cardiac deaths are related to ischemic injury of the myocardium (myocardial infarction). As underlined in the current clinical definition and classification of myocardial infarctions, not all myocardial injuries are due to ischemia: irreversible injury, ending in necrosis, can be induced also by various other factors, such as infections, immune disorders, physical and chemical agents, and trauma. This is supported by clinical studies showing that elevated serum levels of cardiac troponins, as a measure of myocardial damage, are also a common finding in the non-ischemic types of myocardial injury. Forensic pathologists confronted with autopsy findings suggestive of myocardial injury should therefore realize that both ischemic and non-ischemic forms of myocardial death can be observed, and not only in natural but also non-natural deaths (intoxications, asphyxia, traumatic and iatrogenic deaths, and others). Distinguishing these different types of injuries and underlying diseases or circumstances of death is critical, not only to determine the cause and mechanism of death, but also to help investigate often challenging medico-legal scenarios. This article reviews the broad spectrum of ischemic and non-ischemic myocardial injuries in natural and violent deaths. From this perspective we propose a diagnostic approach to myocardial injuries in a forensic pathology context.
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