Fatal arrhythmia associated with myocardial contusion caused by a horse kick: A forensic autopsy case

Horse-related injuries often involve high-energy blunt trauma that can be fatal. In cases of chest trauma associated with horse kicks, death is typically attributed to structural cardiac injuries such as cardiac rupture or tamponade. Fatal arrhythmia associated with myocardial contusion following a horse kick has rarely been reported in the forensic literature.

A 48-year-old man was kicked in the left lower chest by the right hind limb of a Thoroughbred horse while handling the animal. The patient collapsed immediately after the impact. Emergency medical personnel documented ventricular fibrillation and performed repeated defibrillation. Despite advanced resuscitative efforts, including open-chest cardiac massage, death was confirmed.

External examination revealed a patterned abrasion and subcutaneous hemorrhage in the left hypochondrial region. Internal examination revealed a fracture of the left sixth rib, epicardial hemorrhage, and myocardial contusion. Intramyocardial hemorrhage extended into the anterior, lateral, and posterior walls of the left ventricle. Cardiac rupture or hemopericardium was not observed. Histological examination confirmed intramyocardial hemorrhage. Surgical findings related to the resuscitative thoracotomy were also observed.

Based on the circumstances of the incident, prehospital documentation of ventricular fibrillation, and autopsy findings, the cause of death was determined to be fatal arrhythmia associated with blunt chest trauma from a horse kick. This case highlights the importance of considering arrhythmic death as a potential mechanism in horse-related chest trauma, even in the absence of catastrophic structural cardiac injury, and emphasizes its significance in forensic death investigations.