Early Repolarization, Acute Emotional Stress and Sudden Death

Abstract

We herein report the case of a 36-year-old man who died suddenly after a fight with another man. Forensic investigations included unenhanced computed tomography, postmortem angiography, autopsy, histology, neuropathology, toxicology, and biochemistry and allowed a traumatic cause of death to be excluded. An electrocardiogram recorded some years prior to death revealed the presence of an early repolarization pattern. Based on the results of all investigations, the cause of death was determined to be cardiac arrhythmia and cardiac arrest during an emotionally stressful event associated with physical assault. Direct third party involvement, however, was excluded, and the manner of death was listed as natural. The case was not pursued any further by the public prosecutor.

Acute restraint stress provokes sudden cardiac death in normotensive rats and enhances susceptibility to arrhythmogenic effects of adrenaline in spontaneously hypertensive rats

“…Numerous studies have investigated the pathways by which psychological stress and emotional upset lead to sudden death [12,44,45]. However, the mechanisms underlying psychological stress and SCD have not been precisely identified.…”

“…A recent report summarized the various possible pathways by which psychological stress and emotional upset may lead to sudden death [12]. The psychosocial stress-induced neurovegetative changes include the hemodynamic response, autonomic alterations, and neuroendocrine activation as well as inflammatory and prothrombotic responses, all of which are known to have negative influences on the cardiovascular system [1] and may be responsible for the malignant arrhythmia-induced death during psychosocially stressful events [12].…”

“…The psychosocial stress-induced neurovegetative changes include the hemodynamic response, autonomic alterations, and neuroendocrine activation as well as inflammatory and prothrombotic responses, all of which are known to have negative influences on the cardiovascular system [1] and may be responsible for the malignant arrhythmia-induced death during psychosocially stressful events [12]. However, the mechanisms underlying psychological stress and emotional upset, such as acute restraint stress (ARS)-related SCD, have not yet been pinpointed.…”

“…Even with advanced first responder systems, only $5% of those who suffer out-of-hospital cardiac arrest will ultimately survive [14,15]. Ventricular tachycardia (VT) and ventricular fibrillation (VF), are major causes of SCD [15][16][17], along with various arrhythmogenic factors such as left ventricular hypertrophy (LVH) [17], abnormalities in autonomic tone [18] and acute psychosocial stress [12]. LVH due to hypertension is characterized by several electro-physiological abnormalities including prolonged duration of the action potential, decreased resting membrane potential, heterogeneous recovery following depolarization and slowed conduction velocity [17][18][19][20].…”

Sudden gamer death: non-violent death cases linked to playing video games

“…Acute emotional distress (especially anger-like stress) may provoke ventricular arrhythmia, as well as acute myocardial infarction [37,38], but stress due to assault [39] or natural disasters are reported as triggers for SCD, as well [40]. 20 to 40% of sudden cardiac deaths may be precipitated by acute emotional stressors.…”