If a middle-aged man dies suddenly from a heart attack, is it because an enemy or creditor is asking for his life?

There is no scientific basis for saying that an enemy's creditor came to claim his life. This situation is called sudden death syndrome in young adults in forensic medicine.

Sudden death refers to a patient who appears to be healthy but actually has hidden dangers. He dies suddenly due to natural diseases in an unexpectedly short period of time. Sudden manhood death syndrome (SMDS) in young adults is a sudden death of unknown cause.

The World Health Organization believes that the time is within 6 hours, but this is only one company's opinion. It is currently recognized that most people who die within 1 hour of onset are sudden cardiac death.

Overview

Since the name Sudden Death Syndrome in Young Adults was proposed by Tomio Watanabe in Japan in 1977, it has gradually attracted people's attention in forensic examinations. SMDS is frequently reported in foreign literature, but relatively few are reported in China. It has the following characteristics: ① The deceased was in good health, well developed and well nourished; ② The male to female ratio is about 11:1; ③ Most of them are young adults (20 to 40 years old); ④ The deceased died during sleep at night, usually between 2 and 4 in the morning. More common, and occasionally occurs in sudden death during nap; ⑤ Mostly instant death. Symptoms such as moaning, snoring, exclamation, difficulty breathing, and twitching of limbs often occur suddenly during sleep. After being discovered by roommates, they can't wake up after shouting or even pushing. Death occurred immediately; some were found dead in bed in the early morning of the next day; ⑥ Comprehensive systematic forensic pathological examination and poison testing showed no pathological changes that could explain the cause of death. The noteworthy triggers of this disease are overeating before going to bed, lack of sleep, excessive smoking, sexual intercourse, mental stress and excessive physical fatigue, etc. However, most cases of sudden death occur without obvious triggers.

Pathological changes

There are no clear fatal lesions in sudden death syndrome in young adults. The autopsy showed the usual signs of sudden death, including distended jugular veins, dilated pupils, cyanosis of nails and lips, early and thick cadaveric spots, and late and strong rigor mortis. The heart is slightly larger, the right ventricle is dilated, the column of flesh is flat, and there is a large amount of dark red fluid and non-coagulable blood in the cavity. There were no abnormal changes in the epicardium and endocardium. Microscopic examination revealed myocardial fiber rupture, myocardial fiber vacuolar degeneration, and myocardial interstitial edema in most cases. Pulmonary congestion, edema, and small focal bleeding may occur, but there is no inflammatory cell response. There is foamy liquid in the trachea and bronchus. Congestion of liver, spleen, kidney and other solid organs. There may be bleeding under the pancreatic capsule and in the interstitium. In some cases, hyperplasia of thymic lymphoid tissue and thinning of the adrenal cortex can be seen, characterized by fasciculata. Cerebral congestion, edema, and ischemic degeneration of nerve cells. Bleeding spots can be seen on the mucous membranes and serosal surfaces of organs.

Mechanism of Sudden Death

There are different opinions at home and abroad regarding the cause and mechanism of death. Here are several theories:

Acute cardiac death

It is believed that the direct death mechanism is sudden cardiac insufficiency. For example, Baron et al. found that some cases of SMDS have abnormalities in the cardiac conduction system; Kotsu Takatsu and Chen Xinshan et al. found focal loss of myoglobin in myocardial fibers in some SMDS cases. Hu Bingjie et al. found that fibronectin was positive in myocardial cells in some SMDS cases. They believed that It is a manifestation of acute myocardial ischemia.

Primary brain death

Nightmares during sleep. Cerebral cortical activity, including emotional impulses passing through the subcortex and autonomic nerves, affects the heart and respiratory functions. Insufficient blood supply to the brain, and even cerebral ischemia and hypoxia, lead to deepening of brain depression, irreversible transition from lethargy to coma, and brain death during sleep. .

Endocrine factors

Men account for the vast majority of cases of sudden death during sleep. Watanabe said that sudden death syndrome in young adults almost never occurs in women, so the role of endocrine factors in sudden death must be considered. effect. The influence of sex hormones on the blood cholesterol and linoleic acid concentrations of deceased patients with acute heart disease accompanied by pathological changes has been confirmed. When female hormones are injected, serum cholesterol increases and linoleic acid decreases. On the contrary, when male hormones are injected, both cholesterol and linoleic acid increase. Nobuaki Sasano (1978) believed that sudden death during sleep occurs more frequently in men because male hormones can cause atrophy and hypoplasia of the adrenal cortex and insufficient secretion of cortisol. Cortisol secretion is lowest at night.