Sudden cardiac death and acute drunken state: Autopsy study

• Published in: Srpski arhiv za celokupno lekarstvo Vol. 138; no. 9-10; pp. 590 - 594
• Main Authors: Zivkovic, Vladimir, Miletic, Borislav, Nikolic, Slobodan, Jukovic, Fehim
• Format: Journal Article
• Language: English; Serbian
• Published: Serbia Serbian Medical Society 01.09.2010
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; alcohol intoxication; Alcoholic Intoxication - blood; Alcoholic Intoxication - complications; Alcoholic Intoxication - pathology; alcoholism; Alcoholism - complications; Cardiomyopathy, Alcoholic - complications; Child; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Ethanol - blood; Female; forensic pathology; Humans; Male; Middle Aged; sudden cardiac death; Young Adult
• ISSN: 0370-8179; 2406-0895
• DOI: 10.2298/SARH1010590Z

Introduction. Sudden natural death occurs unexpectedly in apparently healthy subjects, or in persons during an apparent benign phase in the course of disease. The most common cause is sudden cardiac death, which is sometimes the first and last manifestation of coronary heart disease. Alcohol directly influences excitation of myocytes, and therefore provokes arrhythmias and possibly, sudden cardiac death. Objective. To establish the frequency of sudden cardiac death in cases of acute alcohol intoxication, to determine blood alcohol concentration at the moment of death, and to determine frequency and level of ethanol intoxication in chronic alcohol abusers, as well as causes of sudden death in those cases. Method. Retrospective autopsy study was performed for a three-year-period. We analyzed cases of sudden natural death, in relation to age and gender, cause of death, and blood alcohol concentration (at least 0.5 g/L). We considered the person to be a chronic alcoholic abuser if gross examination of organs during autopsy showed changes typical for excessive and habitual alcohol consumption. Results. Our sample consisted of 997 cases: 720 men and 277 women, average age 62.0?15.2 years (min=11; max=98). Total of 753 of them died of sudden cardiac death: much more men (?2=167.364; p=0.000), significantly younger than women (t=6.203; p=0.000). We determined acute alcohol intoxication in 73 persons - average blood alcohol concentration 1.85?1.01 g/L (min=0.55; max=3.85), and 61 of them died of cardiovascular diseases (?2=236.781; df=5; p=0.000). Conclusion. In our observed sample, not many persons were under acute alcohol intoxication (around 7%). Most commonly, they were chronic alcohol abusers who died due to exacerbation of chronic heart disease, mildly or moderately intoxicated - the younger, the drunker. Uvod. Prirodna naprasna smrt je iznenadno umiranje prividno zdravih ili ljudi cija bolest nije toliko teska da bi se smrt ocekivala. Najcesce je rec o naprasnoj srcanoj smrti, sto moze biti prva i poslednja manifestacija koronarne bolesti srca. Smatra se da alkohol ima direktno ekscitirajuce dejstvo na miocite i da ovim mehanizmom izaziva poremecaje srcanog ritma i naprasnu srcanu smrt. Cilj rada. Cilj rada je bio da se ustanove ucestalost naprasnih srcanih smrti u stanju akutnog pijanstva, stepen alkoholemije u trenutku smrti u ovim slucajevima, te ucestalost i stepen alkoholisanosti kod hronicnih zavisnika od alkohola ili osoba u toksikomanskoj fazi alkoholizma i uzroke naprasnog umiranja kod njih. Metode rada. Uradjena je retrospektivna autopsijska studija za trogodisnji period. Analizirani su slucajevi naprasnog umiranja usled prirodnih uzroka. Uzorak je analiziran u odnosu na pol i starost ispitanika, uzrok smrti i alkoholemiju u trenutku smrti (najmanje 0,5 g/l alkohola u krvi). Hronicnim zavisnicima od alkohola smatrale su se, pre svega, osobe kod kojih su obdukcijom ustanovljene makroskopske promene na organima nastale usled prekomernog i redovnog konzumiranja alkohola. Rezultati. Uzorak je cinilo 720 muskaraca i 277 zena (997 slucajeva) prosecne starosti od 62,0?15,2 godine (raspon: 11-98 godina). Od naprasne srcane smrti umrla su 753 ispitanika, i to mnogo vise muskaraca (?2=167,364; p=0,000), koji su bili mladji od zena (t=6,203; p=0,000). Ukupno su 73 osobe bile u stanju akutnog pijanstva (prosecna alkoholemija 1,85?1,01 g/l; raspon 0,55-3,85 g/l), a 61 osoba iz ove posmatrane grupe umrla je usled bolesti kardiovaskularnog sistema (?2=236,781; df=5; p=0,000). Zakljucak. Mali je broj osoba umrlih od naprasne srcane smrti u stanju akutnog pijanstva (oko 7%). Najcesce je rec o hronicnim zavisnicima od alkohola koji su umrli usled pogorsanja postojeceg oboljenja srca u stanju blagog ili srednjeg pijanstva. Zapaza se da, sto je osoba bila mladja, to je alkoholemija u trenutku smrti bila visa.