A young male patient had palpitations after consumption of few high caffeinated energy drinks which he took after his office hours to relieve fatigue. He immediately seeked medical help. Electrocardiogram showed multiple runs of non-sustained ventricular tachycardia and ventricular bigeminy and trigeminy. Echocardiography was normal. The patient was admitted to intensive care unit and treated with anti-arrhythmic drugs to which the arrhythmias responded and subsided. Cardiac magnetic resonance imaging of heart did not reveal any structural heart abnormality and treadmill stress test was negative ruling out significant coronary artery disease. High caffeinated energy drinks can produce serious ventricular arrhythmias if taken beyond safe doses. These ventricular arrhythmias are known to be causative factor for sudden cardiac arrest and therefore a caution & regulation is needed in widespread unrestricted used of these drinks.

Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at risk for lethal ventricular arrhythmia, but the electrophysiological substrate behind this is not well-understood. We used non-invasive electrocardiographic imaging to characterize patients with HCM, including cardiac arrest survivors. Methods: HCM patients surviving ventricular fibrillation or hemodynamically unstable ventricular tachycardia (n = 17) were compared to HCM patients without a personal history of potentially lethal arrhythmia (n = 20) and a pooled control group with structurally normal hearts. Subjects underwent exercise testing by non-invasive electrocardiographic imaging to estimate epicardial electrophysiology. Results: Visual inspection of reconstructed epicardial HCM maps revealed isolated patches of late activation time (AT), prolonged activation-recovery intervals (ARIs), as well as reversal of apico-basal trends in T-wave inversion and ARI compared to controls (p < 0.005 for all). AT and ARI were compared between groups. The pooled HCM group had longer mean AT (60.1 ms vs. 52.2 ms, p < 0.001), activation dispersion (55.2 ms vs. 48.6 ms, p = 0.026), and mean ARI (227 ms vs. 217 ms, p = 0.016) than structurally normal heart controls. HCM ventricular arrhythmia survivors could be differentiated from HCM patients without a personal history of life-threatening arrhythmia by longer mean AT (63.2 ms vs. 57.4 ms, p = 0.007), steeper activation gradients (0.45 ms/mm vs. 0.36 ms/mm, p = 0.011), and longer mean ARI (234.0 ms vs. 221.4 ms, p = 0.026). A logistic regression model including whole heart mean activation time and activation recovery interval could identify ventricular arrhythmia survivors from the HCM cohort, producing a C statistic of 0.76 (95% confidence interval 0.72-0.81), with an optimal sensitivity of 78.6% and a specificity of 79.8%. Discussion: The HCM epicardial electrotype is characterized by delayed, dispersed conduction and prolonged, dispersed activation-recovery intervals. Combination of electrophysiologic measures with logistic regression can improve differentiation over single variables. Future studies could test such models prospectively for risk stratification of sudden death due to HCM.

Arterial hypertension is a disease that significantly increases the risk of sudden death in different age groups. It is of high scientific interest to study the relationship of arterial hypertension manifestations with different weather conditions. The article provides a review of literature data on the variability of arterial hypertension course depending on meteorological conditions as a risk factor for sudden death.
Гипертоническая болезнь — заболевание, которое в значительной мере повышает риск развития внезапной смерти в разных возрастных группах. Высокий научный интерес представляет изучение взаимосвязи проявлений гипертонической болезни с разными погодными условиями. В статье приводится обзор данных литературы, посвященных вариабельности течения гипертонической болезни в зависимости от метеоусловий как фактора риска внезапной смерти.

OBJECTIVE: To analyze the contribution of alcohol and drug intoxication to fatal occupational injuries and sudden death at the workplace in Moscow.
METHODS: A number of death cases of various organizations\' employees equal 357 in Moscow in 2023 were investigated. The mean age of the deceased was 48.29±13.9 years, 92.4% of them were men.
RESULTS: Ethanol in blood has been determined in 15% of the deceased. Narcotic drugs and psychotropic medications have been found in 6.7% of cases. Signs of chronic intoxication have been established in 16.5% of the deceased. Chronic intoxication accompanied or aggravated the course of 70% of cardiomyopathies. The proportion of deceased in an accident at an industry or construction site equal 23.9%, as well as 1/2 of the deceased in an accident on the street and in a residential building were impaired by alcohol.
CONCLUSIONS: The study of the contribution of alcohol and drug consumption to occupational mortality will allow to plan measures for reducing the mortality of working-age population.
UNASSIGNED: Анализ вклада алкогольной и наркотической интоксикации в смертельный производственный травматизм и внезапную смерть на рабочем месте в Москве.
UNASSIGNED: Исследованы 357 случаев смерти работников различных организаций на территории Москвы в 2023 г. Средний возраст погибших составил 48,29±13,9 года, 92,4% погибших — мужчины.
UNASSIGNED: У 15% погибших в крови обнаружен этанол. В 6,7% случаев были выявлены наркотические вещества и психотропные лекарственные препараты. У 16,5% погибших установлены признаки хронической интоксикации. Хроническая интоксикация сопутствовала или отягощала течение 70% кардиомиопатий. В состоянии опьянения находились 23,9% погибших в результате происшествия на производстве и стройке, 1/2 погибших в результате происшествия на улице и в жилом здании.
UNASSIGNED: Изучение вклада употребления алкоголя и наркотиков в смертность на производстве позволит планировать меры по снижению смертности трудоспособного населения.

Comparing pace and standard of living of the world population these days and in the end of the last century, it\'s quiet true that there has been a significant increase. Therewith, the number of deaths from cardiovascular diseases has increased in recent decades. Scientists around the world attribute this fact to the increase in the number of people with overweight and other metabolic disorders. Unhealthy lifestyle, namely unbalanced diet, stress, bad habits (smoking, alcohol abuse) leads to metabolic disorders and metabolic syndrome development, that, in turn, can be the main risk factor for complications of associated diseases leading to fatal outcome. The present study gives a forensic description of sudden death in metabolic syndrome, its pathomorphological features were investigated, the causes of death were shown, as well as their relationship with biochemical abnormalities in the body.
Сравнивая темп и уровень жизни населения планеты в настоящее время и в конце прошлого века, нельзя отрицать их существенный рост. Вместе с этим за последние десятилетия произошло увеличение числа смертей от заболеваний сердечно-сосудистой системы. Ученые всего мира связывают данный факт с повышением численности людей с избыточной массой тела и другими нарушениями обмена веществ. Неправильный образ жизни, а именно несбалансированное питание, стресс, вредные привычки (курение, злоупотребление алкоголем) приводят к метаболическим нарушениям и развитию метаболического синдрома, что, в свою очередь, может стать основным фактором риска развития осложнений ассоциированных с ним заболеваний, приводящих к летальному исходу. В настоящем исследовании дана судебно-медицинская характеристика внезапной смерти при метаболическом синдроме, изучены ее патоморфологические особенности, показаны причины смерти, а также их взаимосвязь с биохимическими отклонениями в организме.

暂无摘要。

BACKGROUND: Sudden deaths (SD) in young people including competitive athletes, albeit uncommon, are usually attributable to genetic, congenital or acquired cardiovascular conditions. However, it is under-appreciated that mitral valve prolapse (MVP), a relatively common valvular heart disease, is associated with SD in this youthful population.
METHODS: Forty-three MVP-related SDs are identified from 2 large cardiovascular registries with pathologic, clinical, and demographic findings reported.
RESULTS: Events occurred in both genders, but females were unexpectedly common (49%); median age was 22 ± 8 years, and 29 (67%) were engaged in competitive sports, including 17 with preparticipation examination. Of the 43 MVP cases, 21 died suddenly during or just after vigorous exercise including 6 during organized sports. Sixteen (37%) had been evaluated by a cardiologist resulting in confirmed MVP diagnosis in 11.. Pathologic findings characteristic of MVP included: bileaflet myxomatous involvement in all cases; and areas of interstitial or replacement myocardial fibrosis in 79%, most evident in posterolateral left ventricular wall.
CONCLUSIONS: Arrhythmogenic myxomatous degeneration (MVP) is an under-recognized cause of SD in young people including competitive athletes, disproportionally affecting females and requiring requires a high index of clinical suspicion. Frequency of left ventricular fibrosis in these young people with MVP suggests a mechanism for ventricular tachyarrhythmias and SD, relevant to future risk stratification.

Sudden cardiac death represents a significant diagnostic challenge for forensic pathologists, particularly in inherited arrhythmia syndromes or cardiomyopathies resulting from genetic defects. Molecular autopsies can reveal the underlying molecular etiology in such cases. In this study, we investigated a family with a history of sudden cardiac death to elucidate the molecular basis responsible for sudden cardiac death. The proband underwent a comprehensive forensic examination. Family members received thorough clinical evaluations, including electrocardiogram, Holter monitoring, echocardiography, and cardiac magnetic imaging. Whole exome sequencing and genetic analysis were performed on the deceased and her parents. In addition, Western blotting and patch-clamp recordings were employed to evaluate the expression and function of the mutant protein in vitro. Forensic examination diagnosed arrhythmogenic right ventricular cardiomyopathy (ARVC) as the cause of sudden death. Genetic analysis identified a novel missense mutation in SCN5A (p.V1323L), which was assessed as likely pathogenic by the ACMG guideline. Another family member carrying the mutation manifested long QT syndrome and mild cardiac fibrosis. The cellular electrophysiological study demonstrated that the mutation resulted in an enhanced late sodium current, suggesting it was a gain-of-function mutation. This study characterizes a novel SCN5A mutation that putatively causes long QT syndrome and may contribute to the development of ARVC. Our work expands the pathogenic spectrum of SCN5A variants and underscores the importance of molecular autopsy in sudden death cases, especially in those with suspected genetic disorders.

Background Cardiovascular diseases, especially ischemic heart disease, are the most frequent cause of sudden and unexpected death that constitute a significant portion of the autopsies conducted in our country. Though these deaths may be natural as well as unnatural, they carry medico-legal importance because they occur in a person who has been apparently healthy before the supervening of death, and the cause of death is difficult to ascertain. An infarction can be missed by gross and histological examination within the first few hours of sudden death. 2,3,5-triphenyl-tetrazolium chloride (TTC) is a sensitive histochemical method for diagnosing myocardial infarction within four hours of sudden death. The use of such dyes, hence, can possibly aid in ascertaining the cause of death in such cases wherein there are no known preceding factors. Aim The aim of this article was to study the occurrence of myocardial ischemia by histochemical staining method - 2,3,5-triphenyl-tetrazolium chloride (TTC).  Methods This study involved patients who underwent postmortem examination in the Department of Forensic Medicine and Toxicology, Sri Ramachandra Medical College and Research Institute, Chennai. Results Of 62 cases, 31 cases were found to be positive for TTC staining, and those heart slices were subjected to histopathological examination. The maximum number of cases (77.4%) showed the age of infarction within zero to four hours, which was detected early by TTC staining compared to microscopic changes in the heart. Only seven cases were positive for myocardial infarction by histopathological examination, proving that it is difficult to detect acute infarction if the age of infarction is less than four hours. Conclusion This suggests that for all sudden death cases, 2,3,5-triphenyl tetrazolium chloride could be used as a better tool for the identification of early infarcts.

OBJECTIVE: To explore how emergency nurses experienced caring for brought-in-dead persons and their relatives, and what hindered or facilitated this care in an emergency setting.
METHODS: A qualitative study using Interpretive Description.
METHODS: Data were collected as individual interviews with 13 nurses at seven Danish emergency departments from February to June 2023.
RESULTS: Our analysis revealed the overarching theme \'Navigating the complexities of providing holistic care in a constrained environment\', covering five sub-themes: (1) An important yet not recognized nursing task; (2) Pending care needs of the living and the dead; (3) No physical or mental room for the brought-in-dead persons; (4) Utilizing personal experiences in the absence of formal education and training and (5) Navigating professionalism and empathy.
CONCLUSIONS: Emergency departments posed unique challenges in providing care to brought-in-dead persons and their relatives.
UNASSIGNED: The unrecognized nature of caring for brought-in-dead persons and their relatives suggests a universal undervaluation of this care in emergency departments.
CONCLUSIONS: Care for brought-in-dead persons and their relatives is neither recognized nor evidence-based. This study initiates a discussion of the circumstances for delivering care for persons brought-in-dead and has an impact on nurses and nursing leaders employed in emergency departments.
UNASSIGNED: The Consolidated Criteria for Reporting Qualitative Research (COREQ).
UNASSIGNED: None.