SUDDEN CARDIAC DEATH

Members

1. Amelia Kristin Simanjuntak2. Rosiana C. Uli Pardosi

3. Panji Aryo4. Melati Pratiwi

5. Geraldi Ayub Fujiwan6. Julianita Aritonang

7. Miftakhul Huda

BACKGROUND

Sudden Death in public places Suspected crime scene FORENSICS.

Sudden Cardiac Death (SCD) the biggest cause of sudden death : 79% (Dublin, Connoly Hospital)

Cardiac problems, such as : myocardial infarct (13,49%), heart failure (13,42%) , other heart disease (13,37%). (Depkes, 2009).

IDENTIFYING PROBLEMS

1. Knowing the definition of sudden death.2. Knowing the prevalence of sudden death.3. Knowing the classification of sudden

death.4. Knowing the etiology and pathophysiology

of sudden cardiac death.5. Knowing the external and internal

examination of sudden cardiac death.6. Knowing the further examination of

sudden cardiac death.

OBJECTIVE For Medical Students :

Knowing the general description of sudden cardiac death that can identify cases of sudden cardiac death in the forensic field.

For The Community : Provide knowledge to the community about heart

disease and blood vessel so that the public can be more vigilant in managing a healthy lifestyle.

For The Government : As a base of knowledge to assist the enforcement

of justice in cases of sudden cardiac death.

SCD

CORONARY HEART

DISEASE

HIPERTENSION

STENOSIS AORTA

HEART INFECTION DISEASE

CARDIO-MYOPATHY

Coronary Heart Disease

CARDIOMYOPATHY

PERICARDITIS

Inflammation of the visceral and parietal pericardium with or without the onset of fluid in the cavity is a good pericard transudates or exudates or seraosanguinis or purulent and is caused by a variety of causes

Etiology :

Staphylococcus aureus, Diplococcus pneumoniae, and Streptococcus hemolyticus. Other causes are tuberculosis, Coxsackie virus, rheumatoid, uremia, trauma and idiopathic

bacteriumvirustrauma

inflammation of heart lining

accumulation of pericardial fluid

intracardiac pressure rise

impaired cardiac work

fibrotic process

pericardial thickening

kontriksi pericardial

MTb PERICARDIUM

cardiac tamponade

4TB pericarditis evolutionary

1stageFibrinous Stadium:2,Stadium effusion

3.absorption effusion

4.Pericardial thickening

parieta

3 PHASE hemodynamic

changes

SCD

If so much fluid is accumulated rapidly the heart can not beat normally causing increased pressure in heart the ventricles are not filled perfecly blood pumping becomes ineffective, shocked, and can also cause death.

Forensic Examination of Dead Victims

Things we need to do if we find dead victims are: History Taking Performing an external examination on the

body to identify the victim Checking for signs of the premature death

then determine the time of death Performing Autopsy examination Performing Laboratory examination

External Examination

There are signs of asphyxia in the body that allegedly died due to sudden cardiac death: Cyanosis Systemic dams Bruised body. Edema

Internal Examination

Ischemic heart disease. Coronary artery disease is the cause of

most sudden death. The narrowing and occlusion of the coronary atheroma is the most commonly found.

Sclerosis is common in ramus descendens arteri coronaria sinistra, in the curve of arteri koronaria dekstra, and in ramus sirkumfleksa artery coronaria sisnistra.

The existence of sclerosis with a narrowed lumen in which pin point is sufficient to establish the diagnosis of ischemic.

Artery narrowed by cholesterol containg atheroma.  Note how the tube which the blood flows through has been   narrowed and restricted.

Myocardial infarction is necrosis tissue of cardiovascular disease that can cause death.

Blockage in ramus descending artery coronary sinistra can cause infarction in the front septum chamber, apex, and the front of the wall of the left ventricle.

Meanwhile, the infarction on the back wall of the left ventricle is caused by the obstruction in artery coronary dextra.

An early infarction will manifest as dark areas or hemorrhagic.

While the old infarction will appear solid yellow.

Once the surface of the vessel is damaged, platelet clot accumulates restricting flow.  This may resolve or worsen

Platelets may accumulate so that blood flow is limited by the clot and this causes starvation of oxygen death of muscle and a heart attack.

Internal Examination

Myocarditis The diagnosis of myocarditis in sudden

death can only be confirmed by histopathologic examination

The emergence of interstitial or parenchymal inflammation, edema, fatty, necrosis, degeneration of muscle to miolisis on histopathological examination.

Single-core leukocyte infiltration, plasmosit and histiocytes was evident.

Internal Examination

Artery Disease As a cause of sudden death, the only important

artery disease is one which can be an aneurysm, so it can be easily ruptured.

The result of the ruptured aneurysm depends on the location.

If the rupture occurs in the ascending aortic aneurysm, it may enter the lungs, pleural cavity, medistinum, even the trachea, bronchus and esophagus.

Rupture of the aorta thoracalis pars descendent usually rupture into the pleural cavity.

• On the pars abdominal aortic rupture usually occurs slightly above bifucartio.

Internal Examination

Cardiac Tamponade Cardiac tamponade of emergency

situation in which the fluid is accumulated in the pericardium.

Patients experiencing severe respiratory problems while breathing, the veins in the neck are swollen.

FURTHER EXAMINATIONS

Pathology Anatomy Test

Laboratory Test

Toxicology Test (if had indication)

PHATOLOGY ANATOMY MIOKARD INFARK

Fibrinous Pericarditis

pathology anatomy myokarditis

Lymphocytic myocarditis. Intermediate magnification of myocardium shows diffuse infiltrates composed mostly of lymphocytes but also some neutrophils, macrophages, and plasma cells.

Giant-cell myocarditis

Intermediate magnification in sudden death case shows diffuse infiltration with numerous giant cells, lymphocytes, neutrophils, and eosinophils. Myocyte damage is also present.

Fungal myocarditis

Medium magnification shows nonseptate hyphae within myocardial capillaries in association with lymphocytes and neutrophils.

LABORATORY TEST

Cardiac Enzym es Electrolytes, Calcium, And Magnesium

Cardiac Enzymes

Cardiac Enzymes Start Up Level Peak LevelBack to Normal

Level

CK 3 – 12 hr 12 – 24 hr 3 – 4 days

CK-MB (akt) 3 – 12 hr 12 – 24 hr 2 – 3 days

LDH1 (l HBDH) 6 – 12 hr 48 – 144 hr 7 – 14 days

AST (SGOT) 6 – 12 hr 18 – 36 hr 3 – 4 days

ELECTROLYTES, CALCIUM, AND MAGNESIUM

Severe metabolic acidosis, hypokalemia, hyperkalemia, hypocalcemia, and hypomagnesemia are some of the conditions that can increase the risk for arrhythmia and sudden death.

CONCLUSIONS AND RECOMMENDATIONS

CONCLUSIONS

Sudden death that occurred at 24 hours after the symptoms disappear, but in forensic cases, most of the deaths occurred in a matter of minutes or even seconds after the first symptoms appear. Sudden death is not always the unexpected, and the unexpected death does not always happen suddenly, but very often they fall together on a case.

 

Some diseases of the heart and blood vessels that can lead to sudden death include:o Coronary Heart Disease (Coronary atherosclerosis)o Heart Disease Hypertensiono Heart valve diseaseo Enlargement Cardiomyopathy

O Infection heart disease  

Sudden death occurs four times more frequently in men than women. Diseases of the heart and blood vessels ranks first in causes of sudden death.

In the body of the suspected death due to sudden cardiac death is usually showing signs of asphyxia. Asphyxia can be seen from the external examination, Cyanosis, the lips, the tip - the fingertips and nails, systemic congestion, Bruises bodies, organs and edema

Things to do if they find the first occurrence was sudden, a doctor must gather information to family or relatives nearby, to determine if there is a complaint or previous disease ever suffered by the victim. Second, external and examination bodies, to identify the victim, determine the signs of premature deaths, determining the time of death.

Autopsy examination can be performed to determine the cause and mechanism of death, that is by doing a more thorough examination in organs that are often suspected as the cause of death, such as cardiac, lung, brain, and other organs

Suggestion

Community• To be aware of the number of occurrences of sudden death.• If there are citizens who experience sudden death, should be immediately reported to the authorities, so the doctor can determine the actual cause of sudden death.

Forensic Medicine • More careful in identifying clinical

findings in the examination of sudden death victims.• Need to know how the principles of evidence gathering and its examination so as not to make a lot of evidence and all can be detected during the examination.