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      Hemorragia subendocárdica en fallecidos debido a accidentes de tránsito

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          Abstract

          En una revisión de 13 autopsias médico legales realizadas en el Instituto de Medicina Legal en casos de fallecidos por causas violentas, específicamente vinculados con hechos de tránsito, se encontró que 5 presentaban zonas de hemorragia subendocárdica a nivel de las paredes septal y libre del ventrículo izquierdo del corazón. El resultado de estos estudios es compatible con la hipótesis de la existencia de lesiones cardíacas secundarias a enfermedades no cardíacas, particularmente mediadas por hipersecreción de catecolaminas, como se describe en la literatura en respuesta al daño del sistema nervioso central y el shock. Los hallazgos de estas 5 autopsias fueron revisados y estudiados por las autoras desde el punto de vista macroscópico y las observaciones se hicieron en conjunto lo que garantiza el criterio diagnóstico. En cada caso seleccionado bajo estos criterios, se investigó: alcoholemia, intervalo entre el daño que causó la muerte y la muerte y el predominio de las lesiones traumáticas, entre otros aspectos; lo que se exponen.

          Translated abstract

          On a check up of 13 autopsies done in the Medico Legal Institute on violent death cases, specially those related with traffic accidents, it shown that 5 autopsies presented zones of subendocardic hemorrhage on the left ventricule. The result of this studies is compatible with the hypothesis on the existence of secundary cardiac injuries, measure by hipersecretion of "catecolamines", as it was described in the literature as a response to a damage in the central nervous system and shock The discoveries were studied by the authors from a macroscopic point of view, and the observation was done in groups, wich gives credit to the diagnosis. In each case it was investigated the degree of alcoholism the blood, the space between the accident that cause the death and the death, and the traumatic injuries among others.

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          Most cited references10

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          Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage.

          A study was set up to assess the effect on the clinical course of subarachnoid haemorrhage (SAH) of giving propranolol 80 mg eight-hourly plus phentolamine 20 mg three-hourly by mouth for three weeks. Out of the 90 patients studied, 14 died. Two of the deaths occurred in an open pilot study of 10 patients, the remaining 12 deaths occurring in patients in a randomised double-blind placebo-controlled study. Postmortem examination was carried out on 12 of the patients, six of whom had been receiving placebo and six propranolol plus phentolamine. Necrotic myocardial lesions were present in the hearts of all six patients (age range 30-59 years) who died while taking placebo (all had had abnormal electrocardiograms (ECGs). In contrast, no necrotic lesions were found in the hearts of the six patients (age range 28-59) who died while receiving the drugs (all had previously had normal ECGs). We conclude that the necrotic myocardial lesions were induced by catecholamines and that propranolol had a cardioprotective effect. While death from a further haemorrhage in cases of SAH is not affected by propranolol and phentolamine, propranolol may have a beneficial effect in other potentially lethal stresses.
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            Reduction of stress/catecholamine-induced cardiac necrosis by beta 1-selective blockade.

            114 haemodynamically stable patients with acute head injury were randomised, double-blind, to either placebo or atenolol given intravenously (10 mg every 6 h) for 3 days then orally (100 mg daily) for a further 4 days. Both groups were equally stressed as shown by raised arterial noradrenaline levels. In patients receiving placebo, but not in those receiving atenolol, there was a significant (p less than 0.01) positive correlation between arterial noradrenaline and levels of the myocardial isoenzyme of creatine kinase (CKMB). 30% of the placebo group compared with 7.4% of the atenolol group (p less than 0.05) showed CKMB levels greater than 3% of total creatine kinase (compatible with myocardial damage). CKMB levels greater than 6% of total creatine kinase (compatible with acute myocardial infarction) were present in 16.7% of patients receiving placebo but in no patients receiving atenolol (p = 0.053). Atenolol appeared to reduce significantly the likelihood of supraventricular tachycardia and ST-segment and T-wave changes and prevented cardiac necrosis seen at necropsy.
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              Medicina Legal y Toxicología

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                mlcr
                Medicina Legal de Costa Rica
                Med. leg. Costa Rica
                Asociación Costarricense de Medicina Forense (Heredia )
                1409-0015
                December 1998
                : 15
                : 1-2
                : 70-72
                Article
                S1409-00151998000200021
                b790963b-e029-409e-8239-c51de9c1e5db

                http://creativecommons.org/licenses/by/4.0/

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                Product

                SciELO Costa Rica

                Self URI (journal page): http://www.scielo.sa.cr/scielo.php?script=sci_serial&pid=1409-0015&lng=en
                Categories
                Anatomy & Morphology
                Medicine, Legal

                Social law,Anatomy & Physiology
                head injury,shock,hemorragia subendocárdica,muerte violenta,hechos de tránsito,trauma craneoencefálico,subendocardic hemorrhage,violent death,traffic accidents

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