Sudden cardiac death in elderly: the post-mortem examination of senile myocardium and myocardial infarction
Cardiovascular diseases are the main cause of death globally. From a pathological perspective, the causes of
sudden cardiac death (SCD) are different in young individuals compared with older ones where chronic degenerative
diseases predominate. Most patients with heart disease are elderly, but aging is not synonymous of disease.
Many people live past the age of 65 up to 90 and over without evidence of cardiac diseases and in many
autopsies of elderly individuals, no specific lesions can be discovered that provide a clear cause of cardiac death.
Where age-related changes are observed and no other cardiovascular findings can be related to an arrhythmic or
mechanical mechanism of SCD or to myocardial infarction (MI), the senile myocardial degeneration is an inappropriate
diagnosis although it is a common expression used by public health physicians and pathologists as cause
of death. Age-associated changes in senile myocardium predispose to pathophysiological disease mechanisms
and they can be a substantial substrate causing SCD even after acute emotional or physical stress as triggers
of myocardial ischemia or arrhythmia. However, distinguishing the age-related physiological processes from the
associated pathological changes and their role in a case of SCD is not always possible, since a heart failure (HF)
can be the final cardiovascular aging pathway especially in elderly victims. Furthermore, unnatural deaths can be
erroneously reported as natural deaths, leaving accidents or homicides undetected. The differentiation between
sudden death and fatal elderly abuse is a difficult and critical diagnostic decision that needs a careful post-mortem
investigation also in SCDs. To the best of our knowledge, there is no protocol for distinguishing SCD from
elderly abuse fatalities. A specific protocol for sudden deaths also in elderly (similar to those already available for
infant and child) could enhance the public and professional awareness on elder abuse fatalities as well as on the
underlying mechanisms of cardiac deaths. In cases of sudden, unexpected deaths in healthy elderly, it is strongly
suggested an accurate post-mortem investigation including a complete examination of clinical signs and medical
history, toxicological and/or chemical laboratory tests, circumstantial data related also to the scene-of-the event.
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© Società Italiana di Gerontologia e Geriatria (SIGG) , 2017
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