C. S. Sreedevi 1 , Sreelekshmi J
BACKGROUND Death occurring in apparently healthy individual in a case of natural death may arise suspicion of foul play. In these circumstances these cases may be subjected to medicolegal autopsy. The disease condition may be unknown to the individual and the relatives. This study was done to review the exact cause of death in sudden unexpected deaths, and enabling or assisting the legal authorities in detection of crime, to prove or disprove the foul play. Body mass index is the most frequently used indicator of body fatness. An attempt is made to find out whether there is any significant relationship between BMI and the risk for sudden cardiac death. MATERIALS AND METHODS Data of 50 cases of sudden unexpected death brought for medicolegal autopsy at govt. T.D. medical college Alappuzha in the year 2010 were studied and information were collected from the postmortem records. Data was entered in the proforma. The histopathological examination findings of relevant cases were studied. Analysis was done using MS EXCEL and Chi-square test was used as the test of significance in the comparison between two categorical variables. RESULTS In 50 cases, male predominance was observed and 88% were males in which 50% of males died of atherosclerotic occlusive coronary artery disease and among females 33% died of myocardial infarction. While considering the systemic distribution of cause of death, the cardiovascular system was found to be most commonly affected, 33 cases (66%) followed by respiratory system 7 cases (14%). In 4 (8%) cases gastrointestinal system was affected. In Two cases (4%) central nervous system was affected and others were generalized infection, which constituted 2 cases. Out of 33 cases observed in cardiovascular system the commonest cause being the atherosclerotic occlusive coronary artery diseases involving 27 cases (81.81%) in which the predominant involvement was seen in left anterior descending artery 21 cases (77.77%) followed by right coronary artery, 4 cases (14.8) and left circumflex coronary artery, 2 cases (7.4%). Coronary artery thrombosis and myocarditis constituted two cases (6.6%) each. Sixth decade was commonly affected followed by fifth decade. One case each of cases of rupture of ectopic pregnancy, aneurysmal rupture of cerebral artery and alcoholic steatohepatitis were observed. Respiratory system was involved next to the cardiovascular system in which most common cause was pneumonia, which was found in 3 cases (42.86%). In gastrointestinal system 50% were due to pancreatitis. Persons having normal basal metabolic index was most commonly affected 31 cases (62%) followed by overweight persons 10 cases (20%). Out of 50 cases, 24 (48%) were instantaneous deaths; among them 14 cases were due to myocardial infarction, (58.33%). Others are due to acute haemorrhagic pancreatitis, valvular heart disease, squamous cell carcinoma of larynx, pneumonia, Cardiomyopathy, Rupture of aneurysm, carcinoma of gastro oesophageal junction, myocarditis and alcoholic steatohepatitis. In one case of myocardial infarction there was history of attack by dog, and in 3 cases there was history of mental harassment and in 1 case, physical assault was observed. CONCLUSION From the cases of natural disease brought for medicolegal autopsy it was found that majority of cases were due to cardiac causes. Males were most commonly affected. Sixth decade of age had most cases followed by fourth decade. Pancreatitis, steatohepatitis, rupture of cerebral aneurysm and ectopic pregnancy were rare causes of sudden death encountered in this study. It was observed that physical and mental injury can precipitate or accelerates death in myocardial infarction. It was observed that proportion of cases with normal BMI was high among MI category than non-MI category. But this was not statistically significant.
