A Rare Case of Sudden Cardiac Death

Alhad Mulkalwar; T Jadhav; J Savla; P Vaideeswar

doi:https://doi.org/10.17511/jopm.2021.i06.10

While sudden deaths fall within the purview of forensic experts, they are often found to be caused by cardiovascular pathologies (to the extent of 85%), which may be evident or occult [1]. A sudden cardiac death is an unexpected death owing to a cardiac cause which generally occurs within an hour of onset of symptoms [2, 3]. Most sudden cardiac deaths are due to coronary artery diseases [4, 5]. The remainder is caused by a heterogeneous group of non-ischemic disorders, most of which result in structural cardiac abnormalities [6]. Herein we describe, at autopsy, a case of a sudden cardiac death secondary to an arrhythmogenic cardiomyopathy.

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Alhad Mulkalwar, Intern, Department of Pathology, Seth Gordhandas Sunderdas Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India.
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Alhad Mulkalwar, T Jadhav, J Savla, P Vaideeswar, A Rare Case of Sudden Cardiac Death. Trop J Pathol Microbiol. 2021;7(6):329-331.
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https://pathology.medresearch.in/index.php/jopm/article/view/551

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Accepted

2021-11-10

2021-11-12

2021-11-19

2021-11-26

2021-12-03

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Case description

On 31^st March 2019, a 40-year-old female fell unconscious following an alleged history of chest pain. She was rushed to the casualty of King Edward Memorial Hospital, Mumbai but was declared dead on arrival. Autopsy revealed mildly enlarged ventricles of the heart. There was mild, diffuse adipose tissue infiltration all over, especially over the posterior wall of the left ventricle. A 0.3 cm x 0.3 cm papillary fibroelastoma at the rim of the left coronary ostium was observed [Fig-1]. Histopathological examination of the right ventricle revealed increased epicardial adipose tissue infiltrating the superficial myocardium but without associated fibrosis. Fibers of the myocardium and the endocardium of the right ventricle were completely normal. Myocardium of the left ventricular wall, apex and septum showed mild hypertrophy of fibers with interstitial and perivascular adipose tissue and interstitial fibrosis. These findings were suggestive of a left ventricular dominant arrhythmogenic cardiomyopathy. Histopathology also revealed a focus of thrombus throwing into papillae on the luminal aspect of the origin of the left main coronary artery with extensive adventitial fibrosis and prominent lymphoid aggregate [Fig-2]. The cause of death was concluded to be ostitis of the left main coronary artery with mural thrombosis and associated with arrhythmogenic cardiomyopathy, an extremely rare incidence.

Fig-1: Interior of the heart showing a 0.3cm x 0.3cm papillary fibroelastoma at the rim of the left coronary ostium.

Fig-2: Sections from the left coronary artery - A. Lumen L with thrombus T. Note extreme intimal I fibrocellular thickening (H&E x 250); B. There is marked attenuation of the media M due to transmural destruction by inflammatory cells, lymphocytes and histiocytes and a vague collection of epithelioid cells. (H&E x 250).

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Case Report

Cardiac Death

Tropical Journal of Pathology and Microbiology