Histomorphological Spectrum of Various Cardiac Changes in Sudden Death: An Autopsy Study

Background and Objectives: In spite of large number of studies conducted so far, sudden cardiac death remains an enigma and relative importance of acute coronary events as a trigger of sudden death is currently unclear. An autopsy study of heart was therefore planned to observe various histomorphological cardiac changes, and to determine the frequency association of acute coronary events and myocardial infarction with sudden death. Material and Methods: A prospective randomized study of two hundred autopsied hearts submitted for postmortem analysis was conducted in the Department of Pathology, PGIMS Rohtak over a period of two and a half years from June 2007 to December 2009. The hearts were examined grossly and microscopically to observe various histomorphological changes and findings were correlated clinically. Results: Out of 200 autopsied hearts, 142 (71%) revealed coronary artery atherosclerosis in one or more vessels. Maximum number of cases (32.5%) revealed three vessel diseases. Significant atherosclerosis ( > 50% reduction in diameter) was present in 125 (62.5%) cases, while 58 cases (29%) revealed no observable atherosclerotic change. One hundred twenty cases could be categorized under sudden cardiac death, 15.83% revealed changes of acute MI, 40% of healed MI and 44% revealed no change. Conclusion: The ischemic heart disease was found to be the leading cause of death with coronary atherosclerosis being the most significant pathogenetic mechanism and three vessel disease the most common pattern of involvement. Acute coronary events (occlusive or non-occlusive thrombus/ plaque rupture/ haemorrhage) were observed in only 16% of the cases of sudden coronary death.