“Homicide by Heart Attack” Revisited

Abstract

The sudden death of a person caused by an arrhythmia that is induced by physical and/or emotional stress provoked by the criminal activity of another person is sometimes referred to as “homicide by heart attack.” Published criteria for such an event relate to situations where no physical contact occurs between the perpetrator and the victim. Situations involving physical contact, but with absence of lethal injuries, are frequently treated in a similar fashion by forensic pathologists. Herein, we propose a set of modified criteria, which include cases where physical contact has occurred. Five examples of so-called “homicide by heart attack” are presented, including a 40-year-old man who was struck in the head with a wooden statue, a 74-year-old man who was punched in the jaw by a robber, a 66-year-old woman who was startled awake by a home-intruder, a 67-year-old woman who struggled with a would-be purse-snatcher in a parking lot, and a 52-year-old man who was in a physical altercation with a younger man. In each instance, autopsy revealed the presence of severe, underlying heart disease, as well as absence of lethal injuries. In each case, investigative information was such that the emotional and/or physical stress associated with the criminal activity of another individual was deemed contributory to the death. The presumed mechanism of death in each case was a cardiac dysrhythmia related to underlying heart disease, but initiated by the emotional and/or physical stress.

Evaluation of coronary stenosis with the aid of quantitative image analysis in histological cross sections

“…Moreover, in cases of forensic autopsies it is paramount to have reliable and verifiable data due to the possibility of further legal proceedings. 4,22,24 Quantitative histological image analysis may subvert biases and provides accurate percentages (once tissue shrinkage is taken into account). In this study it is thought that a level of 33% is extreme and that the level of shrinkage should be much lower.…”

Sudden natural death in a suicide attempt

“…In separate accounts, Hirsch, Davis, Malik, Turner, and Prahlow speculated that emotional stresses witnessed in acts of violence, that is, homicides, acutely precipitate a lethal cardiac dysrrhythmia or cause fatal intracranial hemorrhage from a spontaneous rupture of a preexisting arterial aneurysm (1,(16)(17)(18)(19).…”

A case of sudden death following minor intentional trauma; pathologist's contribution to the decision on the manner of death

“…In forensic literature, sudden death of a man resulting from exacerbation of pre-existing heart disease that is induced by physical and/or emotional stress of a criminal activity of another person is sometimes referred to as -homicide by heart attack.‖ 11 In such circumstances it is necessary to prove that the emotional and physical stress associated with the criminal activity of another person was contributory to the death.…”