1/8. Sudden death due to granulomatous myocarditis: a case of sarcoidosis?INTRODUCTION: We report a case of sudden death due to granulomatous myocarditis and propose that cardiac sarcoid could have been the underlying aetiology. This is the first case reported in singapore. The differential diagnoses for granulomatous myocarditis including sarcoidosis and its cardiac manifestations as well as idiopathic giant cell myocarditis are discussed. CLINICAL PICTURE: A 53-year-old Indian woman died suddenly and autopsy revealed bilateral hilar adenopathy and myocardial infiltrates which proved to be granulomatous in nature. CONCLUSION: sarcoidosis may not be a rarity here and it is important to recognise the different clinical manifestations.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
2/8. Enhanced A-V nodal conduction (lown-ganong-levine syndrome) by congenitally hypoplastic A-V node.The basic anatomical substrate of enhanced A-V nodal conduction, manifesting or not as lown-ganong-levine syndrome, is still a controversial issue. We describe the case of a 34-year-old man who presented episodes of ventricular fibrillation. Electrophysiological studies showed that the AH interval was 55 ms, and increased by only 20 ms at paced cycle lengths of 300 ms; atrial pacing induced atrial fibrillation, with a shortest RR interval of 240 ms. Despite verapamil therapy, this patient died suddenly at home. Histological study disclosed a severe A-V node hypoplasia that was evidently congenital in nature; the rest of the conduction system was normal, and no accessory A-V pathways were present. We suggest that enhanced A-V nodal conduction in this patient was due to the developmental defect in the A-V node; this abnormality caused a loss of specific impulse-delaying function, and thus allowed rapid, unfiltered atrial impulses to reach the lower A-V junction and ventricles.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
3/8. A report case of sudden cardiac death in a young adult male from northeastern part of thailand with mitral valve prolapse.A case of sudden unexpected natural death in a young adult male from the north-eastern part of thailand with clinical non Lai-Tai disease, but pathologic feature of mitral valve prolapse is discussed. The approach to the postmortem examination of the mitral valve is reviewed. Because of the sudden nature of this death, this entity is more commonly seen in Medico-legal medicine populations than in hospital autopsies.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
4/8. Sudden death in wolff-parkinson-white syndrome combined with syncope: a case report.Electrocardiogram showing Wolff-Parkinson-White (WPW) pattern in an asymptomatic patient is common, but it is difficult to assess the potential risk of sudden death in such cases. Although the incidence of sudden death in these patients is extremely low, an interventional approach is suggested for all patients despite its controversial nature. syncope, despite being induced by various mechanisms, has been considered an alarming sign of sudden death of WPW syndrome. We describe a 16-year-old female patient with an electrocardiogram that demonstrated a WPW pattern combined with unexplained syncope. None of the examinations, including biochemical profiles, brain computed tomography, transthoracic echocardiography, head-up tilt table test and exercise electrocardiogram, clarified her syncope. Consequently, no further electrophysiologic study was performed for this patient. Unfortunately, the patient suffered sudden death while running. The case highlights the need for vigilance when unexplained syncope combined with WPW syndrome. Such cases have high risk of sudden death, and thus, further interventional study and treatment is indicated.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
5/8. Sudden death due to unsuspected coronary vasculitis.Coronary artery vasculitis is a well-recognized complication of polyarteritis nodosa and is occasionally seen in other forms of systemic vasculitis. However, involvement of the major epicardial coronary arteries leading to myocardial infarction and death is uncommon. Isolated coronary arteritis is even more rare. We report three cases of sudden death due to myocardial ischemia associated with arteritis of the major coronary arteries. All three decedents were previously healthy young to middle-aged men who had died suddenly after complaints of chest pain and shortness of breath. The autopsy findings and differential diagnoses are presented. Such cases are of particular interest to the medical examiner because of the sudden, unexpected nature of the deaths. An approach to the correct diagnosis is discussed.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
6/8. The conduction system findings in sudden cardiac death.This is a brief review of the findings in the conduction system in cases of sudden death victims who were living "normal" active lives. Twenty-two representative samples from more than 100 cases of sudden cardiac death, especially in young and asymptomatic individuals, revealed a plethora of findings that varied from normal to congenital and acquired changes, in most cases either at the gross or microscopic level, especially in the conduction system to a varying degree. Despite these changes, the individuals were living normal, symptom-free lives and were not clinically diagnosed to have lethal cardiac problems. This suggests that these individuals might have experienced lethal arrhythmias in the past, which might have been "silent" in nature. Innovative new methodologies must be developed to detect the silent lethal arrhythmic focus that may lead to sudden cardiac death.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
7/8. ventricular fibrillation and sudden death after radiofrequency catheter ablation of the atrioventricular junction.Two hundred thirty-five patients underwent RF catheter ablation of AV conduction for symptomatic drug refractory AF (84%), atrial flutter (9%), and atrial tachycardia (7%). In the first 100 patients, postablation pacing was not prospectively set at any specific rate and was always < or = 70 beats/min. In the next 135 patients, postablation pacing was prospectively set at 90 beats/min for 1-3 months. Six of the first 100 patients (6%) had VF or sudden death after the RF procedure and none (0%) of the next 135 patients did (P < 0.05). One of the six patients had recurrent VF 4 days after the ablation. Five patients were successfully resuscitated and one patient died. There were no statistically significant differences between patients with and without (aborted) sudden death or between the first 100 and the next 135 patients with respect to age, sex, underlying heart disease, EF, number of RF applications, or left-or right-sided approach of the procedure. VF mostly occurred during episodes of slow ventricular escape rhythms or during slow ventricular pacing. We conclude that malignant ventricular arrhythmias and sudden death are possible complications of RF ablation of the AV function. The mechanism of these complications could have a bradycardia dependent nature and it seems that the occurrence of malignant arrhythmias can be prevented by temporarily pacing the heart at relatively fast rates immediately after ablation.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |
8/8. Utility of magnetic resonance imaging in a patient with anomalous origin of the right coronary artery, acute myocardial infarction, and near-sudden cardiac death.A 46-year-old female presented with an acute myocardial infarction and cardiac arrest. coronary angiography revealed an anomalous origin of the right coronary artery coursing between the aorta and pulmonary artery. magnetic resonance imaging confirmed the life-threatening nature of this anomaly and led to referral for surgical revascularization.- - - - - - - - - - ranking = 1keywords = nature (Clic here for more details about this article) |