Tuesday, March 1, 2011, 7:30 PM
CC 006 A/B
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Sudden Cardiac Death – Expecting The Unexpected
University of Toronto and Toronto General Hospital
Toronto, Ontario, Canada
In accordance with ACCME guidelines regarding disclosure, the USCAP policy requires that faculty members who have a significant financial or other relationship with a commercial company, entity, or service (which will be discussed in this Symposium) must disclose this to attendees. The Academy also requires that speakers disclose any products that are not labeled for the use under discussion. The speakers listed below have indicated they have nothing to disclose.
Barbara Sampson, City of New York, New York, NY
Stephen Cohle, Spectrum-Health Blodgett Campus, Grand Rapids, MI
Jagdish Butany, University of Toronto and Toronto General Hospital, Toronto, Ontario, Canada
Kristopher Cunningham, Office of the Chief Coroner, Toronto, Ontario, Canada
Christina Basso, Istituto di Anatomia Patologica, Padova, Italy
Clinical histories are displayed below.
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Submitted by: Barbara A. Sampson -
A 26yo Hispanic woman with a history of an "unknown cardiac problem" according to the family collapsed dead at home with no antecedent symtoms or complaints.
Case 1 - Slide 1
Submitted by: Stephen D. Cohle -
This 6-year-old boy, wearing a life jacket, fell backward into a swimming pool. Seconds later he was removed from the pool. He was pronounced dead shortly thereafter in an emergency room. He had no family history of sudden death and no history of seizures, syncope, or chest pain. A physical exam 4 months before was unremarkable.
A drug screen was negative.
Shown is a photograph of the right sinus of Valsalva. To the right of the round right coronary ostium is the slit like ostium of the anomalous origin of the circumflex coronary artery (see arrow in enlargement).
Submitted by: Jagdish W. Butany -
Case 3 - Slide 1
Case 3 - Slide 2
Submitted by: Kristopher S. Cunningham -
54 year old man who collapsed and died suddenly while
walking with his wife. Only other history available was
that he was hypertensive and had mild, vague chest pain
approximately one week prior to his death. At autopsy the
most significant abnormality noted was a region of
hemorrhage within the basal interventricular septum.
Submitted by: Cristina Basso -
M.A., Male 33 Year Old
Italian monk was found death in his cell.
Asymptomatic. Healthy past medical history.
No alcohol, smoke and drug addiction.
No 12 lead ECG tracing was available for revision.
Negative family history of sudden death (SD).
Medico-legal autopsy ruled out unnatural and extracardiac causes of death. Tissues, blood and other fluids for toxicology and molecular pathology were taken before fixing the tissues and the whole heart in formalin 10%, as suggested by the European guidelines for autopsy investigation of SD (Basso C et al., 2008).
Gross examination of the heart: Heart weight of 360 gr, transverse diameter 10,5 cm, longitudinal diameter 9 cm. LV wall thickness 10 mm, septal thickness 12 mm, RV free wall 3 mm.
Origin and course of coronary arteries are normal, with a non obstructive eccentric plaque in the left anterior descending branch. Semilunar and atrioventricular valves are normal.
Histology of the myocardium (fig.2). Rare focal inflammatory infiltrates >14 cells/mm2, mostly consisting of T-lymphocyte at immunohistochemistry (CD43 and CD3 positive) were found, in the absence of clear-cut evidence of myocyte necrosis, small vessel disease, and fibro-fatty replacement (fig.1). Myofibers waviness was an additional finding.
The underlying disease at risk of sudden death and differential diagnosis with other conditions will be discussed.
Immunohistochemistry, toxicological panel, and molecular pathology (PCR, RT PCR on heart, spleen and blood) findings will be presented.
1. The heart is normal at gross examination.
2-5. histological sections of the left ventricular myocardium, showing focal mononuclear infiltrates HE (2,4: x250 (3,5: x320, close –up of 2,4).
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