Sudden cardiovascular death

1. Lina Paola Avella Gina Castellanos Raul Castilla Fabian Galarza Natalli Rodriguez Julieth Santos Ximena Tovar Sudden cardiovascular death

2. Contents • Introduction • Evaluation on the clinical history • Sudden death • First article • Cases • Discussion • Second article • Abstract • Discussion

3. Contents • Third article • Abstract • Clinical stages of ARCV • Clinical Diagnostic Criteria of ARCV • Morphological findings at forensic autopsy • Checklist • Histological examination of the heart • Examination of the cardiac conduction system • Laboratory test • Conclusion

4. Video • Video

6. Introduction • Natural deaths > Unnatural deaths. • Sudden unexpected deaths  Cardiovascular diseases: 51.8% • > 80%: Coronary atherosclerosis.

7. Introduction • This requires: • Pathologists: Complex task.

8. Evaluation on the clinical history • The first step • Six groups of information* * Association for European Cardiovascular Pathology

9. Sudden Death

11. Cases

12. Discussion

14. Abstract

15. Discussion

17. Arrhythmogenic right ventricular cardiomyopathy (ARCV) Young Adults Without prior history Cause of sudden death in this age group

18. Clinical Stages of ARCV

19. Clinical Diagnostic Criteria of ARCV

21. Common morphological findings at forensic autopsy • Atheroesclerotic Narrowing of coronary arteries • Myocardal Scar • Dissection of coronary Arteries • Examinate lungs Proximal left Anterior desending A. Leftcircumflexcoronary A.

22. Standard prodedureforexamination of heart (checklist) • Pericardium and pericardial cavity. • Anatomy of the great arteries Valves and trunk Pulmonary Aorta

23. Standard prodedureforexamination of heart (checklist) • Pulmonary veins, superior and inferior veanecavae. • Open Inferior V. cava toapex of theappendage RightAtria Incision LeftAtria Pulmonaryveinsto atrial appendage

24. Standard prodedureforexamination of heart (checklist) SinusNode Esta pendiente una foto mas bonita en donde se mire auricaulas , septum interauricular, y valvulmitrla y tricuspidea se r eciben sugerencias

25. Standard prodedureforexamination of heart (checklist) • Aorta and pulmonary artery including valves • Coronary Arteries Size Shape Position Number Course DOMINANCE

26. Standard prodedureforexamination of heart (checklist) • CoronaryArteries Makemultiplecuts at 3mm intervalsalongepicardial A. • Arteriesagainafterfixation

27. Standard prodedureforexamination of heart (checklist) • Ventricular Disection

28. Standard prodedureforexamination of heart (checklist) • Total Heart weight • Wall thikness • Heart Dimension

29. Standard histological examination of the heart Rightatria and vetricular Leftatria and ventricular Ventricular septum Macroscopicabnormalities • Myocardium • CoronaryArteries Focal Lessions

30. Examination of the cardiac conduction system • Some cases of apparent NUCD without gross cardiac abnormality. • Rare to find lesions at nodes • Blood suply of Nodes before take samples for histology studies. • Sinus / Atrioventicular Nodal Artery • ¼ Cranial Right atrial wall of terminal groove: Sinus Node

31. Cardiac conduction system • Images of nodal and atrioventricular artery • Image of the ¼ right atrial wall

32. Cardiac conduction system • Triangle of Kock • Anterior half of septal leaflet of tricuspid valve for histology • Image of kock`s triangle and sample for histology

33. Cardiac conduction system • Electrophisiologic studies with reentry of miocardial conduction. • Radiofrecuency Ablation • Lethat lesions: • Narrowing of AV Node Artery FibromuscularHiplerplasia AV NodeTumors

34. Laboratory Test • Creatinephosphokinase and isoenzymes • Rised in deaths of cardiac disease • Early MI without evidence on routine histological examination • Measurement in blood and pericardial fluid • Before macro-microscopic evidence of MI • Combined Morphological, Histochemical and Biochemical methods

35. Toxicology • Depending circumstances surrounding the death and tox. data the manner can be accidental, natural or criminal • Even with findings, may have a substance triggered or caused the death? • Young- athlets: Doping or recreational drugs

36. Molecular Pathology • Almost 1/3 of cases have as cause of sudden death • Pathogenic mutation in long QT syndrome • Cathecolaminergic polymorphic ventricular tachycardia = associate genes

37. High Risk Groups • Medical conditions : History of MI or Isquemic Heart Disease, Hipertension, Aortic Stenosis. • Morbid Obesity: • Dilated cardiomyopathy • Severe coronary atherosclerosis • Concentric left ventricular hipertrophy • Young predispose by vigorous weight training + anabolic steroids use to Myocardial injury or even SD

38. Conclusion

39. Any Question?

40. Thanks you