Death Due to Coronary Artery Insufficiency Following Blunt Trauma to the Chest

Abstract

There have been numerous reports of sudden cardiac death following blunt trauma to the chest, but there is lack of such references in forensic literature. It is the court of law which makes decision about trauma precipitating natural events. The forensic pathologist is scientifically trained in the medical field and would be in a better position to give clear picture about the victim's general status at the time of death, exact nature and severity of the illness he is suffering from if any. He can also assess the nature and severity of injuries sustained, and thus, his opinion as to the possible role played by the traumatic event in bringing about the death is valuable. This paper will discuss the mechanism of cardiac injury or possible cardiac injury and sudden death of an apparently healthy 36-year-old male following blunt chest trauma sustained during alleged assault by his neighbor.

Fatal right coronary artery rupture following blunt chest trauma: detection by postmortem selective coronary angiography

“…In cases of myocardial ischemia due to thrombotic occlusion or dissection, it is important to distinguish between intrinsic and extrinsic onset by searching for the presence of a pre-existing vascular lesion (i.e., atherosclerosis) or an underlying medical condition (i.e., pregnancy or fibromuscular dysplasia), in addition to a careful assessment of the temporal relationship between the onset of disease and trauma. If a pre-existing lesion or an underlying condition is detected at autopsy, establishing causality is difficult [3]. In the present case, we judged that the coronary artery dissection and rupture were a result of trauma because there was evidence of application of an external force to the anterior chest (subcutaneous hemorrhage and cardiac contusion), the cadaver showed no specific underlying disease, and the death was temporally related to the assault.…”

“…Many reported cases of coronary artery injury were the result of BCT from a road traffic collision, and the characteristic histological finding is compression of the lumen by hematoma at the site of dissection or surrounding the artery [1][2][3][4][5][6]. Coronary artery rupture is also possible [7], although it has been reported rarely in recent years [8][9][10].…”

Fatal left coronary artery dissection due to blunt chest trauma: A case report and literature review

“…[1][2][3] The most frequent signs associated with the dissection are dyspnoea, chest pain and ST elevation or depression on the electrocardiogram. [4][5][6][7][8][9][10][11][12][13][14][15][16] More importantly, autopsy did not allow this coronary dissection to be diagnosed. Gross examination showed a non-specific haemorrhagic tumefaction of the left anterior descending coronary artery.…”

Coronary artery rupture in blunt thoracic trauma: a case report and review of literature

“…Sudden increase in the transmural pressure of the coronary artery, resulting from compression of the heart between the sternum and spine, might lead to rupture when the increase in pressure exceeds the compliance of the artery. Atherosclerosis results in decreased elasticity of the coronary artery, and turns it into a rigid tube that is more liable to rupture with sudden increases in transmural pressure [ 5 , 10 , 11 ]. This helps to explain why most of the reported cases of coronary artery rupture involve older patients with pre-existing coronary artery disease, which is in contrast to the patient population observed in cases of coronary occlusion, where the majority are below the age of 45 and do not have a pre-existing coronary artery disease.…”

“…Autopsy studies reveal an incidence of around 2 % of all cardiac injuries caused by blunt chest trauma [ 1 , 2 ]. The mechanical energy from trauma transmitted to coronaries can result in intimal tears, wall dissection, dislodgement or rupture of a pre-existing atherosclerotic plaque, coronary artery spasm, or coronary artery rupture [ 1 , 3 – 5 ]. Fractured ribs from blunt trauma can result in coronary laceration [ 6 , 7 ].…”