Autopsy Study of Cardiac Changes in Sudden Cardiac Death in Rural South Tamilnadu

BACKGROUND: Sudden cardiac death (SCD) is a major cause of mortality secondary to coronary artery disease (CAD) in the industrialized societies and its incidence is on the rise in developing countries like ours. Although South Asians have a high prevalence of CAD, the frequency and underlying pathology of SCD among this population are unknown. AIMS AND OBJECTIVES : 1. To describe the morphological changes observed in the hearts of individuals who have succumbed to sudden cardiac death and undergoing autopsy at Tirunelveli Medical College. 2. To study the anatomic and histological evidence of cause of death in sudden cardiac death patients. METHODS: 100 cases of unexplained sudden death, brought for autopsy at Tirunelveli Medical College, were studied. History was collected from the closest relative present. Cardiac pathological findings were analyzed by autopsy followed by histopathological examination with Hematoxylin and Eosin and special stains (masson’s trichrome). Patients with non-cardiac pathology were excluded. All the observations were recorded, compared and analyzed. RESULTS: During a 2 year period, 100 cases were brought to Tirunelveli Medical College with unexplained sudden death. SCD was attributed to myocardial infarction (MI) in 81% of the cases (61 cases were acute and 20 cases were old healed MI); 4% of the hearts showed myocarditis (3 cases of lymphocytic myocarditis and 1 case of eosinophilic myocarditis); 14% of the cohort had normal hearts. CONCLUSION: SCD in rural South India occurred predominantly in men of relatively young age and was most frequently associated with acute MI. Improved health care access, preventive measures and enhanced emergency management may reduce SCD from acute MI in this locale