The current genetic techniques allow us to unmask the etiology behind SCD. We also gave insight into the new radiological techniques, their advantages and related diagnostic pitfalls as compared to that of conventional autopsy. Myocarditis is most often assigned as a cause of death due to a high degree of suspicion of its presence based on a strategy involving many: As a rare disease, myocarditis is poorly understood by most people outside of healthcare and may be unfamiliar even to experienced physicians. The responsible justice department and ethics committee approved this study. 800 Rockmead Drive, Suite 155Kingwood, TX 77339, Copyright 2021 Myocarditis Foundation, 501c3 - EIN #: 20-2657059. SQTS is considered as the severest condition of cardiac channelopathies. Misinterpretation is one of the major pitfalls of radiological examination. 3, 13 March 2015 | Hospital Practice, Vol. Clinical autopsies have always contributed to invention of novel strategies for SCD prevention. 0000003609 00000 n Plaque rupture is the primary event that initiates the process of thrombus formation leading to acute coronary syndrome and SCD [18, 19]. 98 0 obj <>stream 12, Journal of Pediatric Surgery Case Reports, Vol. Polymerase chain reaction (PCR) is one example of the postmortem molecular investigation techniques. The practice in postmortem examination involves a detailed patient and family history, questioning regarding the patients condition before death, as well as, macroscopic and histological studies of the heart with investigations of other organs to exclude non-cardiac causes of death, followed by a genetic testing of a blood sample. 0000001458 00000 n
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195, No. Common genetic mutations associated with inherited cardiac diseases. However, many pitfalls and limitations are encountered with the use of non- forensic autopsies in modern medicine. On the other hand, post mortem magnetic resonance (PMMR) has shown its significant diagnostic ability in postmortem autopsy, mainly in assessing the heart valves, myocardial wall thickness, and ischemic changes [45]. Unlike many human ailments, myocarditis is rarely determined to be the cause of death based on symptoms or physical examinations. Nevertheless, cardiologists seem unsatisfied with the diagnosis reports of these techniques and they find it hard to replace the conventional autopsy. 0000469580 00000 n Sudden arrhythmic death syndromes (SAD) are defined as genetic heart diseases that cause sudden death in young people that apparently look healthy. There are 14 types of LQTS that have been identified based on the gene involved and location of mutation. This is strongly associated with the inaccurate autopsy reports that are difficult to interpret and do not precisely resolve the diagnostic questions. Thus, providing a comprehensive understanding on the advancement of postmortem examination will help improve the minimum standards of routine autopsy practice, develop new guidelines for radiological examination and prevent the growing heterogeneity of the pathologies underlying SCD. These errors include the misdiagnosed or undiagnosed conditions that likely lead to patients death (class I) or do not affect the survival (class II), excluding the over or delayed diagnosis [49]. 71 28 127, No. Coronary atherosclerosis is the most common cause of SCD in individuals aged 35years and above, with men having a higher risk of SCD than women [4], while cardiomyopathies, especially hypertrophic cardiomyopathy (HCM), ion channels defects and coronary artery anomalies are the leading causes of SCD in adults younger than 35years old [7]. 128, No. This field is for validation purposes and should be left unchanged. An abnormal thickening of the coronary arterioles can also be noted [27, 28]. To date our community has made over 100 million downloads. Our team is growing all the time, so were always on the lookout for smart people who want to help us reshape the world of scientific publishing. Thats why Myocarditis Foundation works tirelessly alongside families, patients, researchers, and physicians to support the search for understanding and for a cure. However, in children, myocarditis and congenital heart diseases are the chief causes of SCD [4]. 5, European Heart Journal - Case Reports, Vol. Additionally, screening young athletes for a hidden cardiac pathology has become increasingly demanded before starting physical activity, as SCD can be precipitated during sport, and ECG is one of the most commonly first-line screening tool along with physical examination that are encouraged to be practiced methods in young individuals before engaging in sport activities. Although cardiomyopathies usually depict distinct structural alterations on autopsy, some cases, especially in children may present a structurally normal heart [14]. It has also overcome some families religious objections [13]. 2, Journal of Forensic Radiology and Imaging, Vol. While these histological patterns are not always definitive, they may include those with predominant cell infiltrates: Histology can also provide information about the phase of myocarditis, including: Changes in the heart caused by myocarditis are almost impossible to see with the naked eye even for the most experienced physicians. It is characterized by K+ channel gain-of-function mutations. The presence of a negative autopsy is a strong indicator of the presence of an inherited cardiac arrhythmic disease, this usually require a genetic testing on the victim, a process commonly termed as the molecular autopsy [13]. 129, No. Computed tomography (CT) and Magnetic resonance imaging (MRI) are two imaging modalities that are increasingly used in postmortem investigation of SCD [17]. How? The Cohen coefficient was 0.94.
The rising use of recreational drugs among adolescents and young adults is a common phenomenon seen worldwide. Positive results are followed by non-invasive imaging techniques like echo, CT, MRI among others or invasive ones like angiography and electrophysiological studies [12]. However, a negative macroscopic testing is followed by either a histological or a genetic testing depending on the victims age. 0000000856 00000 n 25, No. Many reasons have been associated with this change, most importantly, the evolution process in the postmortem investigation tools. One of these major challenges is the significant decline of autopsy rate, wherein autopsies are performed after less than 10% of all U.S death. Other markers being tested include complement proteins like C1, C3, C8, C9 and inflammatory mediators such as CD15, IL-1, IL-6, TNF-, IL-15, IL-8, MCP-1, CD18 as well as tryptase which have shown positive results in early hours of ischemia. 61, No. From the Centre for Forensic Imaging and Virtopsy, Institute of Forensic Medicine, University of Berne, Bern, Switzerland (S.G.R., S.B., T.G. 7, International Journal of Legal Medicine, Vol. 2013, 2022 Radiological Society of North America, Heart disease and stroke statistics: 2009 updatea report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee, Discrepancies in initial death certificate diagnoses in sudden unexpected out-of-hospital deaths: the role of cardiovascular autopsy, Role of computed tomography in the evaluation of acute chest pain, Triple rule-out CT in patients with suspicion of acute pulmonary embolism: findings and accuracy, 64-Slice computed tomography angiography in the diagnosis and assessment of coronary artery disease: systematic review and meta-analysis, A systematic review on diagnostic accuracy of CT-based detection of significant coronary artery disease. Their proposed mechanism of action is associated with the development of myocarditis and the ability to cause a prolongation in QT interval which then progresses into a life-threatening arrhythmia [32]. 10, No. Therefore, if SCD occurs in early ischemia before this time frame, these changes will not be detected neither histologically nor macroscopically. This molecular technique, could detect mutations in the genes coding for potassium channels (KCNQ1, KCNH2), sodium channels (SCN5A), and the RYR2 gene which causes tachycardia (CPVT) [39, 40]. Please enter the Page ID of the Facebook feed you'd like to display. 0000001677 00000 n 2, American Journal of Roentgenology, Vol. This arrhythmic disturbance explains the rapidity of the death. The underlying cardiac causes of SCD include coronary artery diseases (CAD), valvular heart diseases, cardiomyopathy syndromes, infiltrative diseases of the myocardium, myocarditis, infective endocarditis, inherited ion channels defects and congenital heart diseases [4, 5]. Feldman AM, McNamara D. Myocarditis. 0000012504 00000 n The hearts of patients who suffered from arrhythmogenic right ventricular dysplasia exhibit microscopic features of fat infiltrating the myocardium, fibrofatty replacement along with patchy areas of myocarditis [18]. This incident is associated with the development of a ventricular tachycardia (VT) which then progresses into a ventricular fibrillation (VF) and eventually asystole is followed [1]. 3, No. Based on the principal type of infiltrating inflammatory cells, it can be classified into lymphocytic, neutrophilic, eosinophilic and giant cell types. Home > Books > Post Mortem Examination and Autopsy - Current Issues From Death to Laboratory Analysis, Submitted: May 15th, 2017 Reviewed: October 9th, 2017 Published: December 27th, 2017, Total Chapter Downloads on intechopen.com. Routine Hematoxylin and Eosin (H&E) stain will detect signs of cellular death and necrosis after 6 to 8hours of ischemia.
The use of medications that can have cardiac effects have been linked to many cases of SCD, such as the antipsychotic medications, some antihistamine drugs, macrolides antibiotics [8], and drugs of abuse; therefore, toxicological substances should always be considered by forensic doctors and screening tests should always be done [9]. 10, The British Journal of Radiology, Vol.
In one cadaver, early myocardial infarction of the papillary muscles had been missed. Minimally invasive or non-invasive autopsy methods have been recently developed and implemented to substitute clinically invasive autopsy. The introduction of post mortem computed tomography coronory angiography (PMCTA) has also been shown to be a very powerful tool in demonstrating the patency of the coronaries, identifying stenotic defects in the coronaries and guiding sampling for histology. Identifying myocarditis as a cause in SCD is often a difficult process as the microscopic findings are not always accurate. 0000001416 00000 n This technique allows us to study the whole genetic library of an individual DNA sample, which is more effective and better than studying a specific gene. Additionally, there is no conventional value for wall thickness and valves circumferences when measured by PMMR, thus further research is required to get cutoff values [45]. By Georgia Sarquella-Brugada, Sergi Cesar, Anna Ferna HeadquartersIntechOpen Limited5 Princes Gate Court,London, SW7 2QJ,UNITED KINGDOM, Kawthar Braysh, Raymond Zerbe, Rosalyn Jurjus Zein, Doureid Oueidat, Jihad Hawi, Luk Oke and Abdo Jurjus, Current Issues From Death to Laboratory Analysis, Post Mortem Examination and Autopsy - Current Issues From Death to Laboratory Analysis, Management of a SCD from the forensic angle, Conventional autopsy vs. non-invasive imaging examination. 0000002002 00000 n Virtopsy, a new imaging horizon in forensic pathology: virtual autopsy by postmortem multislice computed tomography (MSCT) and magnetic resonance imaging (MRI)a feasibility study, Post-mortem forensic neuroimaging: correlation of MSCT and MRI findings with autopsy results, Postmortem whole-body magnetic resonance imaging as an adjunct to autopsy: preliminary clinical experience, Forensic institutes across the world place CT or MRI scanners or both into their mortuaries, Multidetector computed tomography findings in deaths with severe burns, MDCT analysis of projectile injury in forensic investigation, Advances of dual source, dual-energy imaging in postmortem CT, Postmortem angiography: review of former and current methods, Whole body postmortem angiography with a high viscosity contrast agent solution using poly ethylene glycol as contrast agent dissolver, Reduction of postmortem angiography-induced tissue edema by using polyethylene glycol as a contrast agent dissolver, Two-step postmortem angiography with a modified heart-lung machine: preliminary results, Postmortem angiography after vascular perfusion with diesel oil and a lipophilic contrast agent, Postmortem whole-body CT angiography: evaluation of two contrast media solutions, Feasibility of percutaneous organ biopsy as part of a minimally invasive perinatal autopsy, Fat embolism of the lungs as the cause of death: etiology, pathogenesis and reasoning (authors transl) [in German], Herzinsuffizienz, hypertrophie und dilatation, Postmortem imaging-guided biopsy as an adjuvant to minimally invasive autopsy with CT and postmortem angiography: a feasibility study, Postmortem unenhanced magnetic resonance imaging of myocardial infarction in correlation to histological infarction age characterization, Muslim customs surrounding death, bereavement, postmortem examinations, and organ transplants, The impact of declining clinical autopsy: need for revised healthcare policy, Low-tech autopsies in the era of high-tech medicine: continued value for quality assurance and patient safety.