STRESSFUL EVENTS AS A TRIGGER OF SUDDEN-DEATH - A STUDY OF 43 MEDICOLEGAL AUTOPSY CASES

The reports relating emotional stress to sudden death are largely anec dotal. In addition to experimental and electrophysiological studies, a n opportunity for a better understanding of possible stress-related su dden death (SSD) may be provided by medicolegal autopsies. The goal of our autopsy study was to analyze cardiovascular pathologic findings i n cases of SSD and if possible identify mechanisms by which the stress ful event (SE) could be the cause. Forty three cases were studied (29 males and 14 females). In all cases, the SE and the death were witness ed. The age range was 22 to 90 years in males (mean, 52) and 30 to 92 years in females (mean, 64). Death occurred in all cases without premo nitory symptoms. In 20 cases, death occurred during the SE and in the other 23 cases occurred within 2 h of the event. SE included fear, 15 cases; altercation, 21 cases; sexual activity, 3 cases; police questio ning or arrest, 4 cases. According to police reports, in 40 cases (90% ), the victims had no previous clinical history of cardiovascular dise ase. At autopsy, the heart weight in males ranged from 255 to 1000 g w ith a mean of 517 g and in females the range was 250-700 g with a mean of 417 g. In only 3 cases, gross and microscopic examination of the h eart was normal. In 2 of the remaining 40 cases the subjects died of s ubarachnoid hemorrhage. In 38 cases, a cardiac cause of death was foun d as follows: coronary heart disease, 27 cases; cardiomyopathy, 6 case s; aortic valvular stenosis, 2 cases and right ventricular dysplasia, 3 cases. A coronary artery thrombosis was found in 8 cases of sudden c oronary death. Post myocardial infarction fibrosis was present in 25 c ases (92%) of sudden coronary death. In conclusion, it appears from ou r autopsy study that SSD occurs primarily in those individuals with se vere heart disease, especially coronary heart disease.