SUDDEN CARDIAC

DEATH

Members
1.

Amelia Kristin Simanjuntak

2. Rosiana C. Uli Pardosi
3. Panji Aryo
4. Melati Pratiwi
5. Geraldi Ayub Fujiwan
6. Julianita Aritonang
7. Miftakhul Huda

BACKGROUND

Sudden Death in public places

Suspected crime scene FORENSICS.
Sudden Cardiac Death (SCD) the
biggest cause of sudden death : 79%
(Dublin, Connoly Hospital)
Cardiac problems, such as : myocardial
infarct (13,49%), heart failure (13,42%) ,
other heart disease (13,37%). (Depkes,
2009).

IDENTIFYING PROBLEMS
1.
2.
3.
4.

5.

6.

Knowing the definition of sudden death.

Knowing the prevalence of sudden death.
Knowing the classification of sudden death.
Knowing the etiology and pathophysiology
of sudden cardiac death.
Knowing the external and internal
examination of sudden cardiac death.
Knowing the further examination of sudden
cardiac death.

OBJECTIVE

For Medical Students :

For The Community :

Knowing the general description of sudden

cardiac death that can identify cases of sudden
cardiac death in the forensic field.
Provide knowledge to the community about heart
disease and blood vessel so that the public can
be more vigilant in managing a healthy lifestyle.

For The Government :

As a base of knowledge to assist the enforcement

of justice in cases of sudden cardiac death.

CORON
ARY
HEART
DISEAS
E
CARDIOMYOPATH
Y

HEART
INFECTI
ON
DISEASE

SC
D

HIPERTENSI
ON

STENOS
IS
AORTA

onary Heart Disease

CARDIOMYOPATHY

PERICARDITIS
Inflammation of the visceral and parietal
pericardium with or without the onset of
fluid in the cavity is a good pericard
transudates or exudates or
seraosanguinis or purulent and is caused
by a variety of causes

Etiology :
Staphylococcus aureus, Diplococcus
pneumoniae, and Streptococcus
hemolyticus. Other causes are
tuberculosis, Coxsackie virus,
rheumatoid, uremia, trauma and
idiopathic

bacterium
virus
trauma

inflammation of heart lining

accumulation of pericardial
fluid
intracardiac pressure rise
impaired cardiac work
fibrotic process
pericardial thickening
kontriksi pericardial

MTb

PERICARDIU
M

TB pericarditis
evolutionary
1stage
Fibrinous
Stadium:
2,Stadium
effusion
3.absorption
effusion
4.Pericardial
thickening
parieta

3 PHASE
hemodynamic
changes

SCD

cardiac
tamponade

If so much fluid is accumulated rapidly

the heart can not beat normally
causing increased pressure in heart
the ventricles are not filled perfecly
blood pumping becomes ineffective,
shocked, and can also cause death.

Forensic Examination of Dead Victims

Things we need to do if we find dead

victims are:

History Taking
Performing an external examination on the
body to identify the victim
Checking for signs of the premature death
then determine the time of death
Performing Autopsy examination
Performing Laboratory examination

External Examination

There are signs of asphyxia in the body

that allegedly died due to sudden
cardiac death:

Cyanosis
Systemic dams
Bruised body.
Edema

Internal Examination

Ischemic heart disease.

Coronary artery disease is the cause of

most sudden death. The narrowing and
occlusion of the coronary atheroma is the
most commonly found.
Sclerosis is common in ramus
descendens arteri coronaria sinistra, in
the curve of arteri koronaria dekstra,
and in ramus sirkumfleksa artery
coronaria sisnistra.

The existence of sclerosis with a narrowed lumen in

which pin point is sufficient to establish the diagnosis of
ischemic.

Artery
narrowed
by
cholesterol
containg
atheroma.
Note how the tube which
the blood flows through
has been narrowed and
restricted.

Myocardial infarction is necrosis tissue of

cardiovascular disease that can cause
death.
Blockage in ramus descending artery
coronary sinistra can cause infarction
in the front septum chamber, apex, and
the front of the wall of the left ventricle.
Meanwhile, the infarction on the back
wall of the left ventricle is caused by the
obstruction in artery coronary dextra.

An early infarction will manifest as dark

areas or hemorrhagic.
While the old infarction will appear solid
yellow.

Once the surface of the vessel

is damaged, platelet clot
accumulates restricting flow.
This may resolve or worsen

Platelets may accumulate so

that blood flow is limited by
the clot and this causes
starvation of oxygen death of
muscle and a heart attack.

Internal Examination

Myocarditis

The diagnosis of myocarditis in sudden

death can only be confirmed by
histopathologic examination
The emergence of interstitial or
parenchymal inflammation, edema, fatty,
necrosis, degeneration of muscle to miolisis
on histopathological examination.
Single-core leukocyte infiltration, plasmosit
and histiocytes was evident.

Internal Examination

Artery Disease

As a cause of sudden death, the only important

artery disease is one which can be an
aneurysm, so it can be easily ruptured.
The result of the ruptured aneurysm depends
on the location.

If the rupture occurs in the

ascending aortic
aneurysm, it may enter the
lungs, pleural cavity,
medistinum, even the trachea,
bronchus and esophagus.
Rupture of the aorta
thoracalis pars descendent
usually rupture into the
pleural cavity.

On the pars
abdominal aortic
rupture usually
occurs slightly above
bifucartio.

Internal Examination

Cardiac Tamponade

Cardiac tamponade of emergency

situation in which the fluid is accumulated
in the pericardium.
Patients experiencing severe respiratory
problems while breathing, the veins in the
neck are swollen.

FURTHER EXAMINATIONS

Pathology Anatomy Test

Laboratory Test

Toxicology Test (if had

indication)

PHATOLOGY ANATOMY
MIOKARD INFARK

Fibrinous Pericarditis

pathology anatomy
myokarditis

Lymphocytic myocarditis. Intermediate magnification of

myocardium shows diffuse infiltrates composed mostly of
lymphocytes but also some neutrophils, macrophages, and plasma
cells.

Giant-cell myocarditis

Intermediate magnification in sudden death case shows diffuse infiltration

with numerous giant cells, lymphocytes, neutrophils, and eosinophils.
Myocyte damage is also present.

Fungal myocarditis

Medium magnification shows nonseptate hyphae within myocardial

capillaries in association with lymphocytes and neutrophils.

LABORATORY TEST

Cardiac Enzym es
Electrolytes, Calcium, And Magnesium

Cardiac Enzymes
Cardiac Enzymes

Back to Normal

Start Up Level

Peak Level

CK

3 12 hr

12 24 hr

3 4 days

CK-MB (akt)

3 12 hr

12 24 hr

2 3 days

LDH1 (l HBDH)

6 12 hr

48 144 hr

7 14 days

AST (SGOT)

6 12 hr

18 36 hr

3 4 days

Level

ELECTROLYTES, CALCIUM, AND

MAGNESIUM

Severe metabolic acidosis, hypokalemia,

hyperkalemia,
hypocalcemia,
and
hypomagnesemia are some of the
conditions that can increase the risk for
arrhythmia and sudden death.

CONCLUSIONS AND
RECOMMENDATIONS

CONCLUSIONS

Sudden death that occurred at 24 hours

after the symptoms disappear, but in
forensic cases, most of the deaths
occurred in a matter of minutes or even
seconds after the first symptoms appear.
Sudden death is not always the
unexpected, and the unexpected death
does not always happen suddenly, but
very often they fall together on a case.

Some diseases of the heart and blood

vessels that can lead to sudden death
include:
o Coronary Heart Disease (Coronary
atherosclerosis)
o Heart Disease Hypertension
o Heart valve disease
o Enlargement Cardiomyopathy

O Infection heart disease

Sudden death occurs four times more

frequently in men than women. Diseases
of the heart and blood vessels ranks first
in causes of sudden death.

In the body of the suspected death due

to sudden cardiac death is usually
showing signs of asphyxia. Asphyxia can
be seen from the external examination,
Cyanosis, the lips, the tip - the fingertips
and nails, systemic congestion, Bruises
bodies, organs and edema

Things to do if they find the first

occurrence was sudden, a doctor must
gather information to family or relatives
nearby, to determine if there is a
complaint or previous disease ever
suffered by the victim. Second, external
and examination bodies, to identify the
victim, determine the signs of premature
deaths, determining the time of death.

Autopsy examination can be performed

to determine the cause and mechanism
of death, that is by doing a more
thorough examination in organs that are
often suspected as the cause of death,
such as cardiac, lung, brain, and other
organs

Suggestion
Community
To be aware of the number of
occurrences of sudden death.
If there are citizens who experience
sudden death, should be immediately
reported to the authorities, so the doctor
can determine the actual cause of
sudden death.

Forensic Medicine
More careful in identifying clinical
findings in the examination of sudden
death victims.
Need to know how the principles of
evidence gathering and its examination
so as not to make a lot of evidence and all
can be detected during the examination.