![]() whether it correlates to the nature of the disease under consideration or to the timescale expected by the history available) or when identified in a younger person, whether there may be an underlying genetic contribution to the disease. Moreover, being able to interpret the macroscopic and microscopic findings within the myocardium enables the pathologist to proffer an opinion on the severity of the disease present, whether the pathology identified is adequately explained by the clinical history available (i.e. As a result, pathologists may not “see” other forms of hypertrophy when they encounter it and understand what such hypertrophy says about the pathophysiological processes that were at play in the months to years prior to death and at what stage in its natural history the myocardial disease is being evaluated. Yet concentric LVH represents only one pattern of cardiac hypertrophy that may be observed at autopsy. When most physicians undergo their training, cardiac hypertrophy is often presented as being concentric in nature and caused by increased afterload impedance from conditions such as hypertension or aortic stenosis. Nevertheless, the spectrum of how myocardial hypertrophy can present at autopsy and the significance of such hypertrophy for the death investigation may not be fully appreciated by all pathologists. Thus, myocardial hypertrophy is a stable, chronic pathological substrate that is well recognized to increase the risk of ventricular arrhythmias, cardiac failure and sudden cardiac death. Finally, LVH elevates the risk of myocardial infarction as well as cardiovascular morbidity and mortality in patients with hypertension. The incidence of myocardial hypertrophy will likely increase at the time of autopsy as the age of the population increases and the proportion of individuals with chronic comorbidities such as obesity, hypertension and chronic kidney disease escalates in western society. ![]() LVH is an independent risk factor for coronary artery disease and increases the risk of congestive heart failure 10-fold by 16 years. In patients with definite electrocardiographic (ECG) evidence of LVH there is a 59% overall mortality at 12 years. Significant left ventricular hypertrophy (LVH) increases the risk of sudden cardiac death 6- to 8-fold in men and 3-fold in women. This is where the careful consideration of any myocardial hypertrophy identified is warranted. In the absence of a clear alternative cause for death following evaluation of all information available, including a complete autopsy with additional ancillary studies where appropriate, such as toxicology, biochemistry and microbiology, it is reasonable to consider that death (or the circumstances leading to death) may be best explained as the result of an acute arrhythmic event caused by some underlying cardiac substrate. Forensic pathologists frequently face the circumstance where an individual is witnessed to die suddenly and unexpectedly or is found deceased, despite appearing entirely well a short time earlier. Myocardial hypertrophy may not only underlay some sudden, natural deaths, but also deaths that occur by accidental means, such as following sudden loss of consciousness while operating a motorized vehicle or a large piece of machinery in the workplace or under circumstances where there is struggle and restraint by police at the time of apprehension. It represents a pathological substrate that is associated with arrhythmogenesis and for the forensic pathologist may help explain why on individual may die suddenly and unexpectedly. Myocardial hypertrophy is a common finding at autopsy.
0 Comments
Leave a Reply. |
Details
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |