Evaluation of sudden cardiac death cases with preceding minor physical/ emotional trauma
Ümit Naci Gündoğmuş, Muhammet Demir, Uğur Çom, Hüsrev Demirel, Yiğit Sezer, Ali Tavaslı, Hüseyin Oflaz
Abstract: Background. Relationship between emotional stress and sudden cardiac death (SCD) has long been speculated.
Establishing the causality between incident (whether involving apparent minor physical trauma or not) and death is an important
medicolegal issue while signing the death certificate.
Methods. Illuminating the characteristics of autopsy and crime scene findings of SCDs with preceding physical minor
trauma with/or emotional/psychological trauma (quarrel), we reviewed the exact cause of death reports of 1st Specialisation
Board of Council of Forensic Medicine between 2007-2011 and evaluated for type of trauma, previous medical and cardiac
disease history, place of death, time period between trigger and death and autopsy findings.
Results. A marked male predominance was observed (90%). 89.3% of the cases were at the age of 40 and above. 82.5% of
the cases (n=99) were claimed to be exposed to physical trauma, and 17.5% (n=21) were claimed to be exposed to only emotional/
psychological trauma (due to quarrel). There was not any finding of physical trauma in 23.3% (n=28), and there were findings of
mild trauma in 76.7% (n=92) of the cases. In 63.3% of the cases, cardiac symptoms appeared at the time of incident and symptoms
appeared within one or two hours after the incident in 18.3% of the cases. In 80.8% of the cases, death occurred within the first
24 hours after the incident. 62.3% were over-weight and obese. Cardiac weights were 400 g and above in 72.2% of the cases. Acute
MI findings were observed in 21.4%, and chronic changes in 76.8% of the myocardium in microscopic examination.
Conclusion. Length of time between trigger and SCD is very important during the establishment of the causality and
clarifying the other causality related legal issues. Detailed autopsy is very important in SCD cases triggered by a stressful event
with or without minor physical trauma. Keywords: sudden cardiac death, autopsy, emotional trauma/stress, minor physical trauma.