Emedinews - Insight on medicolegal issues: Sudden death-autopsy -four cases found dead in toilet during daily pursuits

Left ventricular hypertrophy is the second leading cause of sudden cardiac death in the adult in India. 

• The longstanding raised high blood pressure which has caused secondary damage to the wall of the main pumping chamber of the heart, the left ventricle. Once again, hypertrophy is associated with cardiac arrhythmias.

• The mechanism of death in a majority of patients dying of sudden cardiac death is ventricular fibrillation and as a consequence there may be no prodromal symptoms associated with the death.

• These patients may be going about their daily business and suddenly collapse without the typical features of myocardial infarction such as chest pain and shortness of breath. There are a number of cases in which patients feel the effect of myocardial ischaemia. Myocardial ischaemia is associated with referred pain, classically to the front of the chest, the left arm and the jaw. Patients may feel generally unwell, with nausea, dizziness and vomiting.

• These symptoms may precede the death for any length of time between a few minutes and several hours.

• I had conducted the postmortem examination of four cases found dead in toilet during daily pursuits the cases of left ventricular hypertrophy resulted into sudden death. 

(Contributed by Dr Sudhir Gupta)