Incidence of sudden cardiac death in clinical and forensic context.

B. Barabas

Abstract: Incidence of sudden cardiac death in clinical and forensic context. Our study tried to evaluate the time of onset and the frequency of sudden cardiac death diagnosis both in clinical and in medical legal case load. The purpose of the study was to find a unified clinical and medical-legal approach of Sudden Death and also a classification, useful in determining different types of SCD by using the time elapsed from the onset of various symptoms to the moment of death. Two study groups were defined: (1) clinical group and (2) medical-legal group. The clinical group was divided into two subgroups: (1a) a clinical group with cardiovascular patients that lived after hospitalization (Lcl-v) and (1b) cardiovascular patients that died during hospitalization (Lcl-d). The patients were randomly selected from all cardiovascular patients (3906) in Cardiology section from Brasov County Hospital in 2004. Medical legal group (Lmleg) contained all SCD cases in which a medical-legal autopsy was performed according to 114 Article from Penal Procedure Code (15 years retrospective research). The most common etiology for Lcl-v patients was atherosclerosis and ischemic heart disease (58%), out of which 10% (369 cases) were hospitalized with acute myocardial infarction. 4% died of various cardiovascular causes. When comparing in Lmleg versus Lcl-d group we notice that SC death more frequently found in the first group. The study of medical-legal cases showed that 75% of sudden death cases can be included in sudden cardiac death category, by being included in the definition of SCD (cardiac death in less than one hour from the onset of the symptoms). We propose the following systematization of SCD: SCD0 (SCD with witnesses, in less than one minute from the onset of the events), SCD1 (SCD with witnesses, in less than one hour from the onset of the events), SCD24C (SCD with witnesses up to 24 hours from the first symptoms in a clinical context), SCD24F (SCD without witnesses in a medical legal context in which that person was seen alive within 24 hours). We believe this unitary medical-legal-clinical classification would permit a more refined evaluation of the phenomenon of SCD
Keywords: sudden cardiac death, forensic medicine, cardiology