Journal of Forensic Science and Medicine

EDITORIAL
Year
: 2022  |  Volume : 8  |  Issue : 4  |  Page : 133--134

Sudden cardiac death in forensic medicine


Dong Zhao1, Feng Chen2,  
1 Key Laboratory of Evidence Science (China University of Political Science and Law), Ministry of Education, Beijing, China
2 Department of Forensic Medicine, Nanjing Medical University, Nanjing, Jiangsu, China, China

Correspondence Address:
Dr. Feng Chen
Department of Forensic Medicine, Nanjing Medical University, Nanjing, Jiangsu 211166
China




How to cite this article:
Zhao D, Chen F. Sudden cardiac death in forensic medicine.J Forensic Sci Med 2022;8:133-134


How to cite this URL:
Zhao D, Chen F. Sudden cardiac death in forensic medicine. J Forensic Sci Med [serial online] 2022 [cited 2023 Feb 3 ];8:133-134
Available from: https://www.jfsmonline.com/text.asp?2022/8/4/133/366421


Full Text

Sudden cardiac death (SCD) is a major public health problem and a devastating event for the family and for the community as well. It is estimated that approximately 544,000 SCDs each year in China.[1] The etiology of SCD has been extensively studied.[2],[3] Ischemic heart disease is responsible for up to 70% of SCDs, whereas other structural heart diseases and primary arrhythmia account for the majority of the remaining SCDs. Postmortem diagnosis of SCD has been challenging for forensic pathologists, and SCD is a hot field of forensic research.[4]

The scope of this special issue is to present original research works, interesting case reports, and the most updated review articles on what we know about SCDs in the field of forensic medicine. The aim of this issue is to provide readers with further insight into the current and future research perspectives.

In this special issue of SCD in forensic medicine, we have included eight articles. The original research was conducted to evaluate the diagnostic efficiency of analyses of N-terminal pro-brain natriuretic peptide (NT-proBNP), Cardiac troponin T/I (cTnT), and creatine kinase-MB (CK-MB) in the pericardial fluid for forensic diagnosis of SCD caused by ischemic heart disease. The study indicated that postmortem biochemical analyses of NT-proBNP, cTnT, and CK-MB in the pericardial fluid may assist to diagnose SCD in forensic practice, and the combined analyses of multiple biomarkers have better diagnostic efficiency than single biomarkers alone.

Relative quantification of FBW7, KLF5, FGFBP1, and FGFBP2 mRNAs in myocardial tissue samples was performed using real-time fluorescence-based quantitative reverse transcription polymerase chain reaction. KLF5 and FGFBP1/2 protein levels were examined using immunohistochemistry. Their results indicated that quantitative detection of FBW7, KLF5, FGFBP1, and FGFBP2 mRNA transcripts in myocardial tissues, supports the pathophysiological study of myocardial ischemic diseases, and provides molecular pathological evidence for differentiating causes of death in SCD patients.

A review of the application and prospect of postmortem imaging technology in forensic cardiac pathology is presented. The review described the applications of the latest postmortem imaging and its related technologies in forensic cardiac pathology, including advantages, limitations, and development prospects.

An overview of the most updated information on SCDs is presented. This review systematically introduces the epidemiology of SCD, types of cardiac arrest, leading to sudden death, sudden coronary death, sudden death due to cardiomyopathy, sudden death due to myocarditis, mixed and multiple arrhythmogenic substrates, mitral valve prolapse, cardiac tumors and sudden death, commotio cordis, sudden death without morphologic findings, and molecular autopsy.

A review of exosome biomarkers in cardiovascular diseases and its prospective forensic application in the identification of SCD is presented. This review summarizes the current advances of exosomes in cardiovascular disease in a disease-oriented manner and provides a reference for future forensic pathological identification of SCD, as well as the early diagnosis of SCD in a clinic.

Further review of SCD and cardiac sodium channel diseases is also presented. This review discusses the relationship between SCD and sodium channel diseases, clarifies the underlying mechanisms, and provides family members at risk with genetic counseling for potential cardiac channel diseases.

One case report was an acute attack due to coronary heart disease in a 47-year-old pregnant woman. The patient was admitted to the hospital for gestational hypertension. During her hospitalization, she developed sudden onset of chest tightness, palpitation, and dyspnea while having an elective cesarean section. She died 21 days later despite extensive resuscitation efforts. Autopsy findings revealed that she had significant coronary atherosclerotic stenosis and cardiomegaly with biventricular dilatation. In addition, a hard foreign body with sharp edges was embedded in the esophagus near the right pyriform. The patient's sudden death was attributed to coronary heart disease, while the esophageal foreign body impaction was considered to be a concomitant phenomenon. Their findings raise the question: what was the role of the esophageal foreign body impaction in the patient's death?

Another case report was a 26-year-old woman who was found dead at home. She had a history of unexplained syncope. An autopsy examination revealed evidence of any significant natural diseases or trauma. Postmortem toxicological analysis was negative for drugs or alcohol. Reviewing the patient's medical records and her previous electrocardiograph (ECG) indicated that her ECG showed a QTc interval of 539 ms which implicates the diagnosis of long QT syndrome (LQTS). The case report highlighted the importance of clinicopathological corrections in the cases of SCD due to LQTS, which helps the forensic pathologist better understand postmortem diagnosis of SCD with nonstructural cardiac diseases.

In summary, postmortem diagnosis of SCD requires systemic autopsy examination, including toxicological analysis. Gross and microscopic examination of the cardiovascular system may identify many organic heart diseases, such as atherosclerotic coronary diseases, cardiomyopathy, aortic aneurysm, dissection, and so on. However, molecular testing of certain biomarkers and genetic etiological investigation can be very important to assist in the determination of the cause of death in SCD patients and to provide family members with further genetic counseling, such as risk factors of ion channel diseases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

References

1Zhang S. Sudden cardiac death in China: Current status and future perspectives. Europace 2015;17 Suppl 2:i14-8.
2Ulbricht J, Madea B, Doberentz E. Histological examination of carotid artery tissue in cases of ligature strangulation and hanging. Forensic Sci Res 2022;7:247-54.
3Du Long R, Fronczek J, Niessen HW, van der Wal AC, de Boer HH. The histopathological spectrum of myocardial inflammation in relation to circumstance of death: A retrospective cohort study in clinical and forensic autopsies. Forensic Sci Res 2022;7:238-46.
4Lou J, Chen H, Huang S, Chen P, Yu Y, Chen F. Update on risk factors and biomarkers of sudden unexplained cardiac death. J Forensic Leg Med 2022;87:102332.