Heart's appearance after cardiac arrest

Kitkitdizzi

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Hey awesome peeps! I've seemed to hit a dead end with Google and PubMed, and before I start bugging my dad's cardiac surgeon I was hoping someone here might know the answer to my question. Here it is:

Got a victim who dies of ventricular fibrillation (he was literally scared to death). He's young, healthy, and had no other heart problems. When the pathologist performs the autopsy, would the heart look weird/have any damage to it that would be visible to the naked eye or with a simple, one-lens microscope? The story is secondary world, and the closest time frame equivalent is the early 19th century, so the lab wouldn't have access to modern medical diagnostic equipment.

Thanks!
 

MaeZe

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Being scared into having a heart attack is a bit of a myth. As far as I know, the best you can do is say nothing was found on the autopsy to explain the cardiac arrest. That should work in a fiction scenario.
 

GeorgeK

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Being scared into having a heart attack is a bit of a myth.
Not a myth just highly unlikely and would require some extenuating circumstances such as a variety of pathologies or medications or lack of appropriate medication, which then leads to the question of is it really the fright or those pathologies and or medications. The fright would be the proximate cause, with the others as secondary. You can call it semantics if you want.

To the OP, no there would not likely be anything on a direct visual exam of the heart. Death would be quick enough that the changes would be uniform as opposed to if they had had a heart attack a week ago and finally died, then there would be necrotic areas fed by the vessel that became blocked during the heart attack.
 

Albedo

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Some of the pathologies that can lead to sudden cardiac death, though, could be obvious even to an early 19th Century pathologist, e.g. dilated or hypertrophic cardiomyopathy. Is it important that they actually be physically healthy?
 

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I think the heart would look normal from the outside.

Sudden cardiac death in an otherwise healthy young man does happen. Your scenario for ventricular fibrillation is plausible. The cause could be what is known as long QT syndrome (there are several of these), an inherited disorder of the heart that can also be worsened by various medications. This can suddenly go into a form of ventricular fibrillation known as torsade de pointes. That can be fatal or it can self-resolve. The person may have a history of sudden fainting spells.
 

josephperin

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If it is a primarily electrophysiological problem, you don't need to have a single thing visibly abnormal on autopsy.

If you absolutely need to give him anatomical changes, this article may help.

http://circ.ahajournals.org/content/98/21/2334

ETA - depending on how technical you want to get about it, Brugada syndrome will probably be the way to go. Can cause VFib. Men have a worse outcome from Brugada.
 
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Kitkitdizzi

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Being scared into having a heart attack is a bit of a myth. As far as I know, the best you can do is say nothing was found on the autopsy to explain the cardiac arrest. That should work in a fiction scenario.

Not a myth just highly unlikely and would require some extenuating circumstances such as a variety of pathologies or medications or lack of appropriate medication, which then leads to the question of is it really the fright or those pathologies and or medications. The fright would be the proximate cause, with the others as secondary. You can call it semantics if you want.

To the OP, no there would not likely be anything on a direct visual exam of the heart. Death would be quick enough that the changes would be uniform as opposed to if they had had a heart attack a week ago and finally died, then there would be necrotic areas fed by the vessel that became blocked during the heart attack.

Well, the idea I had was the murderer kills their victims by inducing such fear that their heart fails (although in one of the victims the stress causes a brain aneurysm to rupture). My hypothetical method for this is that the increased adrenaline opens the ion channels and sodium floods the heart, disrupting electrical signaling and causing vfib, after which blood pressure plummets and the victim dies. From the scientific articles I've read this sounds plausible, and I'm not yet sure how much of my research will go into the story (definitely not the stuff that wouldn't be known to a 19th century pathologist--most of this is just for my benefit, because, well, I have to know). I should probably shoot this idea to a cardiologist just to be sure.

Some of the pathologies that can lead to sudden cardiac death, though, could be obvious even to an early 19th Century pathologist, e.g. dilated or hypertrophic cardiomyopathy. Is it important that they actually be physically healthy?

In this case, I'm trying to play the game of stump the pathologist. I don't want them to see heart disease and conclude that's what killed the victim. But I wasn't sure if they could look at a heart and say 'oh, they experienced ventricular fibrillation' due to some damage they could see. Some of the other victims do have heart problems that are discovered during their autopsies.

I think the heart would look normal from the outside.

Sudden cardiac death in an otherwise healthy young man does happen. Your scenario for ventricular fibrillation is plausible. The cause could be what is known as long QT syndrome (there are several of these), an inherited disorder of the heart that can also be worsened by various medications. This can suddenly go into a form of ventricular fibrillation known as torsade de pointes. That can be fatal or it can self-resolve. The person may have a history of sudden fainting spells.

If it is a primarily electrophysiological problem, you don't need to have a single thing visibly abnormal on autopsy.

If you absolutely need to give him anatomical changes, this article may help.

http://circ.ahajournals.org/content/98/21/2334

ETA - depending on how technical you want to get about it, Brugada syndrome will probably be the way to go. Can cause VFib. Men have a worse outcome from Brugada.

Great article! I did look into the pathophysiology of both torsade de pointes and Brugada syndrome, with Brugada kinda being the jumping point to figuring out how this would work.

Thank you everyone for your insight! It's sounding like the pathologist won't find anything abnormal about the victim's heart, which is totally fine in the story. I just couldn't find any references to how a heart would look in a healthy person who died of sudden cardiac arrest that was not attributed to a disease (which I guess is because it wouldn't look any different!)
 

MaeZe

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Not a myth just highly unlikely and would require some extenuating circumstances such as a variety of pathologies or medications or lack of appropriate medication, which then leads to the question of is it really the fright or those pathologies and or medications. The fright would be the proximate cause, with the others as secondary. You can call it semantics if you want....
Like I said, scared to death is a myth. Semantics indeed. When a person with underlying cardiac pathology is stimulated in any number of ways such as shoveling snow, running, or experiencing fear, the increased heart rate and blood pressure can of course, lead to cardiac arrest.

The death would be attributed to cardiac arrest resulting from acute stress on the cardiovascular system.

But without that underlying pathology, severe fright won't cause healthy people to die of cardiac arrest, so it would be pure fiction to write a killer using it. On the other hand, we are talking about fiction.
 

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While being scared to death really isn't a thing, Sudden Cardiac Death is. There are a few genetic disorders that can cause SDC, and to someone in the 19th century it could look like they were scared to death, and in a way they, they are.

I think the answer you're looking for is Hypertrophic cardiomyopathy. It was the cause of death for Hank Gathers and Reggie Lewis, both young, athletic men who suffered sudden cardiac death. SCD can be brought on by physical activity or a massive shock that would dump catecholamines into your system. Anyone doing a basic autopsy would notice a thickening in the heart muscles

The other possibility is Marfan syndrome, which has a whole list of physiological effects on the body that again, would be noticed on an autopsy.
 

GeorgeK

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But without that underlying pathology, severe fright won't cause healthy people to die of cardiac arrest, so it would be pure fiction to write a killer using it. On the other hand, we are talking about fiction.
And we are talking about potentially a killer knowing the medical history of the victim and what to do with it, how to exploit it. As long as there's a reasonable explanation it can work. But yeah,on a realism stand population statistics point you have a valid argument. It's just that writers deal with often the nonpopulationstatistics and zero probability is different than near zero probability.
 

josephperin

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If it is a serial killer story, it wouldn't work. even with Brugada or Athlete's Heart. The killer would need to know that the intended victim had a habit of fainting. Perhaps the doctor told him to avoid getting too excited, since this was 19th century.

ETA - Serial killer attacking football teams? There has to be a good horror story in there.
 
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MaeZe

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And we are talking about potentially a killer knowing the medical history of the victim and what to do with it, how to exploit it. As long as there's a reasonable explanation it can work. But yeah,on a realism stand population statistics point you have a valid argument. It's just that writers deal with often the nonpopulationstatistics and zero probability is different than near zero probability.
I missed that bolded part. This is from the OP
Got a victim who dies of ventricular fibrillation (he was literally scared to death). He's young, healthy, and had no other heart problems.

Bottom line, we don't disagree.
 

Kitkitdizzi

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Hmm...I suppose it is a faux pas on my part to say the victims are literally scared to death. I guess I was thinking more along the lines of the fear and stress triggering a physical response that leads to death. The story concept is the killer is using supernatural powers to induce horrific visions that the victims believe are actually happening (kinda Freddy-Kreugerish, but what's happening to them in their visions is not reflected on their real body). Perhaps more in line with sudden arrhythmic death syndrome? Does that make sense?
 

MaeZe

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Hmm...I suppose it is a faux pas on my part to say the victims are literally scared to death. I guess I was thinking more along the lines of the fear and stress triggering a physical response that leads to death. The story concept is the killer is using supernatural powers to induce horrific visions that the victims believe are actually happening (kinda Freddy-Kreugerish, but what's happening to them in their visions is not reflected on their real body). Perhaps more in line with sudden arrhythmic death syndrome? Does that make sense?
As long as you're going with the supernatural element, I see no reason you can't scare people to death. When the heart rhythm is the cause of a heart stopping, there may not be any tell-tale indicators on autopsy. The more common form of heart attack is a blood vessel closing off. That would show on the autopsy. Go with the rhythm disturbance.
 

Kitkitdizzi

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Again, thank you to everyone for your input. Reppies all around :D. My story wheels are turning, and since the heart will look normal on the autopsy I think that may be a good hint to my pathologist that something is not quite right.
 

josephperin

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Again, thank you to everyone for your input. Reppies all around :D. My story wheels are turning, and since the heart will look normal on the autopsy I think that may be a good hint to my pathologist that something is not quite right.

Ah. Not if you want to be credible.

While cardiac arrest need not show up as changes obvious to the naked eye, death brings several changes to the heart. BUT you wouldn't be able to tell if it was from a primarily arrhythmic cause.
 

Kitkitdizzi

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Ah. Not if you want to be credible.

While cardiac arrest need not show up as changes obvious to the naked eye, death brings several changes to the heart. BUT you wouldn't be able to tell if it was from a primarily arrhythmic cause.

Sorry, I'm not sure what you mean. Are you referring to something other than normal decomp? (When I said normal, I meant normal in the sense of autopsy not showing signs of heart disease or other pathology that would clue in to cause of death)
 

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