Forensic aspects of sudden autopsy-negative cardiac death

Khalikov A.A.; Kuznetsov K.O.; Iskuzhina L.R.; Khalikova L.V.

doi:https://doi.org/10.17116/sudmed20216403159

Khalikov A.A.

Bashkir State Medical University

ORCID: 0000-0003-1045-5677

Kuznetsov K.O.

N.I. Pirogov Russian National Research Medical University

ORCID: 0000-0002-2405-1801

Iskuzhina L.R.

Bashkir State Medical University

Khalikova L.V.

Bashkir State Medical University

Forensic aspects of sudden autopsy-negative cardiac death

Authors:

Khalikov A.A., Kuznetsov K.O., Iskuzhina L.R., Khalikova L.V.

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Journal: Forensic Medical Expertise. 2021;64(3): 59‑63

DOI: 10.17116/sudmed20216403159

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To cite this article:

Khalikov AA, Kuznetsov KO, Iskuzhina LR, Khalikova LV. Forensic aspects of sudden autopsy-negative cardiac death. Forensic Medical Expertise. 2021;64(3):59‑63. (In Russ.)
https://doi.org/10.17116/sudmed20216403159

Подписка 2026 Судебно-медицинская экспертиза (Forensic Medical Expertise)

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Abstract:

The review of the world literature on the most common causes, mechanism of development and diagnostic signs of sudden autopsy-negative cardiac death is presented. Two groups of reasons for the development of this pathology were identified — traumatic and non-traumatic. The traumatic group includes the cardio-inhibitory reflex and the trigemino-cardiac reflex. The non-traumatic group included prolonged Q—T interval syndrome, Brugada syndrome, catecholaminergic polymorphic ventricular tachycardia. The importance of postmortem molecular genetic research in cases of sudden cardiac death in order to prevent the deaths in the victim’s relatives is noted. The criteria for the diagnosis of reflex cardiac arrest are indicated.

Keywords:

sudden cardiac death

reflex cardiac arrest

molecular autopsy

arrhythmia

forensic medicine

Authors:

Khalikov A.A.

Bashkir State Medical University

ORCID: 0000-0003-1045-5677

Kuznetsov K.O.

N.I. Pirogov Russian National Research Medical University

ORCID: 0000-0002-2405-1801

Iskuzhina L.R.

Bashkir State Medical University

Khalikova L.V.

Bashkir State Medical University

Received:

26.11.2020

Accepted:

23.12.2020

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References:

van der Werf C, Hendrix A, Birnie E, Bots ML, Vink A, Bardai A, Blom MT, Bosch J, Bruins W, Das CK, Koster RW, Naujocks T, Schaap B, Tan HL, de Vos R, de Vries P, Woonink F, Doevendans PA, van Weert HC, Wilde AA, Mosterd A, van Langen IM. Improving usual care after sudden death in the young with focus on inherited cardiac diseases (the CAREFUL study): a community-based intervention study. Europace. 2016;18(4):592-601. https://doi.org/10.1093/europace/euv059
United Nations Economic Commission for Europe. UNECE statistical database. https://w3.unece.org/pxweb
Suárez-Peñaranda JM, Cordeiro C, Rodríguez-Calvo M, Vieira DN, Muñoz-Barús JI. Cardiac Inhibitory Reflex as a Cause/Mechanism of Death. J Forensic Sciences. 2013;58(6):1644-1647. https://doi.org/10.1111/1556-4029.12212
Sandu N, Schaller B. The trigemino-cardiac reflex: a view to the future. Arch Med Sci. 2010;6(1):138-139. https://doi.org/10.5114/aoms.2010.13523
Kauferstein S, Kiehne N, Jenewein T, Biel S, Kopp M, König R, Neumann T. Genetic analysis of sudden unexplained death: A multidisciplinary approach.Forensic Science International. 2013;229(1-3):122-127. https://doi.org/10.1016/j.forsciint.2013.03.050
Wakita R, Ohno Y, Yamazaki S, Kohase H, Umino M. Vasovagal syncope with asystole associated with intravenous access. Oral Surg, Oral Med, Oral Pathol, Oral Radiol and Endod. 2006;102(6):28-32. https://doi.org/10.1016/j.tripleo.2006.06.005
Schrag B, Mangin P, Vaucher P, Bollmann MD. Death caused by cardioinhibitory reflex: what experts believe. Am J Forensic Med Pathol. 2012;33(1):9-12. https://doi.org/10.1097/paf.0b013e3181db7efd
Schrag B, Vaucher P, Bollmann MD, Mangin P. Death caused by cardioinhibitory reflex cardiac arrest--a systematic review of cases. Forensic Sci Int. 2011;207(1-3):77-83. https://doi.org/10.1016/j.forsciint.2010.09.010
Saukko P. Suffocation and «asphyxia». In: Saukko P, Knight B, editors. Knight’s forensic pathology, 3rd edn. New York: Arnold; 2004.
Alboni P, Brignole M, Menozzi C, Raviele A, Del Rosso A, Dinelli M, Bettiol K, Bottoni N, Solano A. Clinical spectrum of neurally mediated reflex syncopes. Europace. 2004;6(1):55-62. https://doi.org/10.1016/j.eupc.2003.09.003
Bolliger S, Plattner T, Zollinger U. The deadly broomstick: an unusual missile injury to the neck. Am J Forensic Med Pathol. 2006;27(4):304-306. https://doi.org/10.1097/01.paf.0000221084.57365.16
Schmidt P, Madea B. Reflex mechanisms of death in missile injuries of the neck. Forensic Sci Int.1994;66(1):53-60. https://doi.org/10.1016/0379-0738(94)90319-0
Schrag B, Vaucher P, Bollmann MD, Mangin P. Death caused by cardioinhibitory reflex cardiac arrest — a systematic review of cases. Forensic Sci Int. 2011;207(1-3):77-83. https://doi.org/10.1016/j.forsciint.2010.09.010
Schaller B. Trigeminocardiac reflex. A clinical phenomenon or a new physiological entity? J Neurol. 2004;251(6):658-665. https://doi.org/10.1007/s00415-004-0458-4
Bohluli B, Ashtiani AK, Khayampoor A, Sadr-Eshkevari P. Trigeminocardiac reflex: a MaxFax literature review. Oral Surg,Oral Med Oral Pathol, Oral Radiol and Endod. 2009;108(2):184-188. https://doi.org/10.1016/j.tripleo.2009.03.050
Dillon M, Power A, Mannion C. Trigeminocardiac reflex. Br J Oral Maxillofac Surg. 2017;55(4):445-446. https://doi.org/10.1016/j.bjoms.2016.11.006
Rossi R, Lodise M, Lancia M, Bacci M, De-Giorgio F, Cascini F. Trigemino-Cardiac Reflex as Lethal Mechanism in a Suicidal Fire Death Case. J Forensic Sciences. 2004;59(3):833-835. https://doi.org/10.1111/1556-4029.12408
Lynch MJ, Parker H. Forensic aspects of ocular injury. Am J Forensic Med Pathol. 2000;21(2):124-126. https://doi.org/10.1097/00000433-200006000-00006
Belih AN. Fatal injury to the reflexogenic zones of the neck, caused by blows to the hands and feet. Aktual’nie voprosi sudebnoi meditsini. 1986;27-29. (In Russ.).
Baburin AA, Shtarberg RS, Kostrikov RV. Sudden death due to blunt trauma of the reflex zone. Klinicheskaya i patomorfologicheskaya diagnostika redko vstrechajushichsya povrejdenii i zabolevanii. 2015;9:36-38. (In Russ.).
Kapustin AV, Pavlov NN. To the diagnosis of death from reflex cardiac arrest. Sudebno-meditsinskaya expertiza. 1987;3:10-12. (In Russ.).
Stattin EL, Westin IM, Cederquist K, Jonasson J, Jonsson BA, Mörner S, Norberg A, Krantz P, Wisten A. Genetic screening in sudden cardiac death in the young can save future lives. Int J Legal Med. 2016;130(1):59-66. https://doi.org/10.1007/s00414-015-1237-8
Tester DJ, Ackerman MJ. The molecular autopsy: should the evaluation continue after the funeral? Pediatr Cardiol. 2012;33(3):461-470. https://doi.org/10.1007/s00246-012-0160-8
Evans A, Bagnall RD, Duflou J, Semsarian C. Postmortem review and genetic analysis in sudden infant death syndrome: an 11-year review. Hum Pathol. 2013;44(9):1730-1736. https://doi.org/10.1016/j.humpath.2013.01.024
Schwartz PJ, Stramba-Badiale M, Segantini A, Austoni P, Bosi G, Giorgetti R, Grancini F, Marni ED, Perticone F, Rosti D, Salice P. Prolongation of the QT interval and the sudden infant death syndrome. N Engl J Med. 1998;338(24):1709-1714. https://doi.org/10.1056/NEJM199806113382401
Garcia AJ 3rd, Koschnitzky JE, Ramirez JM. The physiological determinants of sudden infant death syndrome. Respir Physiol Neurobiol. 2013;189(2):288-300. https://doi.org/10.1016/j.resp.2013.05.032
Crotti L, Celano G, Dagradi F, Schwartz PJ. Congenital long QT syndrome. Orphanet J Rare Dis. 2008;3:18. https://doi.org/10.1186/1750-1172-3-18
Skinner JR. Is there a relation between SIDS and long QT syndrome? Arch Dis Child. 2005;90(5):445-449. https://doi.org/10.1136/adc.2004.057935
George AL Jr. Inherited disorders of voltage-gated sodium channels. J Clin Invest. 2005;115(8):1990-1999. https://doi.org/10.1172/JCI25505
Tester DJ, Ackerman MJ. The role of molecular autopsy in unexplained sudden cardiac death. Curr Opin Cardiol. 2006;21(3):166-172. https://doi.org/10.1097/01.hco.0000221576.33501.83
Campuzano O, Sarquella-Brugada G, Cesar S, Arbelo E, Brugada J, Brugada R. Update on Genetic Basis of Brugada Syndrome: Monogenic, Polygenic or Oligogenic? Int J Mol Sci. 2020;21(19):7155. https://doi.org/10.3390/ijms21197155
Chen PS, Priori SG. The Brugada syndrome. J Am Coll Cardiol. 2008;51(12):1176-1180. https://doi.org/10.1016/j.jacc.2007.12.006
Ruan Y, Liu N, Priori SG. Sodium channel mutations and arrhythmias. Nat Rev Cardiol. 2009;6(5):337-348. https://doi.org/10.1038/nrcardio.2009.44
Shimizu W. Clinical impact of genetic studies in lethal inherited cardiac arrhythmias. Circ J. 2008;72(12):1926-1936. https://doi.org/10.1253/circj.cj-08-0947
Priori SG, Napolitano C, Memmi M, Colombi B, Drago F, Gasparini M, DeSimone L, Coltorti F, Bloise R, Keegan R, Cruz Filho FE, Vignati G, Benatar A, DeLogu A. Clinical and molecular characterization of patients with catecholaminergic polymorphic ventricular tachycardia. Circulation. 2002;106(1):69-74. https://doi.org/10.1161/01.cir.0000020013.73106.d8
Tester DJ, Kopplin LJ, Will ML, Ackerman MJ. Spectrum and prevalence of cardiac ryanodine receptor (RyR2) mutations in a cohort of unrelated patients referred explicitly for long QT syndrome genetic testing. Heart Rhythm. 2005;2(10):1099-1105. https://doi.org/10.1016/j.hrthm.2005.07.012
Laitinen PJ, Brown KM, Piippo K, Swan H, Devaney JM, Brahmbhatt B, Donarum EA, Marino M, Tiso N, Viitasalo M, Toivonen L, Stephan DA, Kontula K. Mutations of the cardiac ryanodine receptor (RyR2) gene in familial polymorphic ventricular tachycardia. Circulation. 2001;103(4):485-490. https://doi.org/10.1161/01.cir.103.4.485
Eldar M, Pras E, Lahat H. A missense mutation in the CASQ2 gene is associated with autosomal-recessive catecholamine-induced polymorphic ventricular tachycardia. Trends Cardiovasc Med. 2003;13(4):148-151. https://doi.org/10.1016/s1050-1738(03)00025-2
Piholkin JuI, Todorov SS, Berezovskiy DP, Kolomoec IA, Oganesyan NS. Forensic medical diagnosis of sudden death of young people based on morphological analysis of the cardiac conduction system. Sudebno-meditsinskaya expertiza. 2020;63(5):39-42. (In Russ.). https://doi.org/10.17116/sudmed20206305139
Lee A, Ackerman MJ. Sudden unexplained death: evaluation of those left behind. Lancet. 2003;362(9394):1429-1430. https://doi.org/10.1016/S0140-6736(03)14726-5