Forensic medical estimation of the morphological changes in the myocardium and hypothalamo-pituitary-adrenal system in case of sudden cardiac death

This morphological, morphometric, and immunohistochemical study of the myocardium, adrenal gland, and hypothalamus included 50 corpses of men aged from 25-49 years deceased by reason of acute coronary failure associated with coronary heart disease. The commonest lesions in the myocardium were contractures (54.3 +/- 3.5% [51.2; 57.8%]), cyclic deformation (44.7 +/- 6.3% [38.2; 51.4%]), and dissociation of cardiomyocytes (61.2 +/- 2.3% [56.3; 64.8%]). The sinoatrial and atrioventricular nodes of the heart contained large amounts of adrenaline-positive cells (45.6 +/- 4.5% [40.1; 48.7%]) and 34.2 +/- 2.9% [31.2; 37.4%]). The equally large numbers of adrenaline-positive cells were detected in the adrenal medulla (67.2 +/- 6.8% [61.9; 74.3%]). The arcuate, supraoptic, and paraventricular nuclei of the hypothalamus underwent reversible changes of neutron content (the degree of damage 25.6 +/- 4.8% [21.2; 29.8%]) and contained large amounts of noradrenaline-positive and dopamine-positive neural cells (54.2 +/- 3.6% [51.4; 59.3%]) and 28.7 +/- 2.1% [23.4; 31.7%]) respectively. It is concluded that the morphometric and immunohistochemical changes detected in the present study can be used as the additional forensic medical criteria for diagnostics of death from acute coronary failure associated with coronary heart disease.