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      Sudden cardiac death—update

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          Abstract

          Sudden cardiac death (SCD) is one of the most common causes of death worldwide with a higher frequency especially in the young. Therefore, SCD is represented frequently in forensic autopsy practice, whereupon pathological findings in the heart can explain acute death. These pathological changes may not only include myocardial infarction, coronary thrombosis, or all forms of myocarditis/endocarditis but also rare diseases such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system, or primary cardiac tumours.

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          Recognizing COVID-19-related myocarditis: the possible pathophysiology and proposed guideline for diagnosis and management

          Bhurint Siripanthong, Saman Nazarian, Daniele Muser … (2020)
          Human coronavirus-associated myocarditis is known, and a number of COVID-19-related myocarditis cases have been reported. The pathophysiology of COVID-19-related myocarditis is thought to be a combination of direct viral injury and cardiac damage due to the host’s immune response. COVID-19 myocarditis diagnosis should be guided by insights from previous coronavirus and other myocarditis experience. The clinical findings include changes in ECG, cardiac biomarkers, and impaired cardiac function. When cardiac MRI is infeasible, cardiac CT angiography with delayed myocardial imaging may serve to exclude significant coronary artery disease and identify myocardial inflammatory patterns. Because many COVID-19 patients have cardiovascular comorbidities, myocardial infarction should be considered. Where the diagnosis remains uncertain, an endomyocardial biopsy may help identify active cardiac infection through viral genome amplification and possibly refine the treatment risks of systemic immunosuppression. Arrhythmias are not uncommon in the COVID-19 patients; however, its pathophysiology is still speculative. Nevertheless, clinicians should be vigilant to provide prompt monitoring and treatments. The long-term impact of COVID-19 myocarditis, including in the majority of mild cases remains unknown.
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            Neurohumoral features of myocardial stunning due to sudden emotional stress.

            Ilan Wittstein, David Thiemann, Joao Lima … (2005)
            Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown. We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class III myocardial infarction. The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress-induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons). Emotional stress can precipitate severe, reversible left ventricular dysfunction in patients without coronary disease. Exaggerated sympathetic stimulation is probably central to the cause of this syndrome. Copyright 2005 Massachusetts Medical Society.
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              Myocarditis: The Dallas criteria

              H. Thomas Aretz (1987)
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                Author and article information

                Contributors
                P. Markwerth:
                ORCID: http://orcid.org/0000-0002-1341-7417
                philipp.markwerth@uk-essen.de
                Journal
                Journal ID (nlm-ta): Int J Legal Med
                Journal ID (iso-abbrev): Int J Legal Med
                Title: International Journal of Legal Medicine
                Publisher: Springer Berlin Heidelberg (Berlin/Heidelberg )
                ISSN (Print): 0937-9827
                ISSN (Electronic): 1437-1596
                Publication date (Electronic): 21 December 2020
                Publication date PMC-release: 21 December 2020
                Pages: 1-13
                Affiliations
                [1 ]GRID grid.410718.b, ISNI 0000 0001 0262 7331, Institute for Forensic Medicine, , University Hospital Essen, ; Hufelandstr. 55, 45122 Essen, Germany
                [2 ]GRID grid.411067.5, ISNI 0000 0000 8584 9230, Institute for Forensic Medicine, , University Hospital Gießen, ; Giessen, Germany
                Author information
                http://orcid.org/0000-0002-1341-7417
                Article
                Publisher ID: 2481
                DOI: 10.1007/s00414-020-02481-z
                PMC ID: 7751746
                PubMed ID: 33349905
                SO-VID: cd2c82b8-5e02-4e28-ba86-c8ad0b3a8079
                Copyright © © The Author(s) 2020
                License:

                Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

                History
                Date received : 22 July 2020
                Date accepted : 9 December 2020
                Funding
                Funded by: Projekt DEAL
                Open Access :

                Open Access funding enabled and organized by Projekt DEAL.

                Categories
                Subject: Review

                ScienceOpen disciplines: Law
                Keywords: sudden cardiac death (scd),forensic aspects,acute death,death in the young,common cause of death
                Data availability:
                ScienceOpen disciplines: Law
                Keywords: sudden cardiac death (scd), forensic aspects, acute death, death in the young, common cause of death

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