Myocardial Infarction and Rupture of the Left Ventricle After Sexual Intercourse-Juniper Publishers
Juniper Publishers-Journal of Cardiology
A 59 year old caucasian male
died after having sex with a prostitute. The medicolegal autopsy
reported a sudden death due to hemopericardium tamponade associated with
myocardial infarction and coronary artery disease. As a comorbidities
we considered the death was related to overweight and type 2 diabetes.
Sudden death reported during sexual intercourse has low incidence rates
but when it occurs while having extramarital sexual activity, a thorough
study of the cause, manner and circumstances of death is required.
Keywords: Sudden death; Hemopericardium; Medicolegal autopsy
Introduction
Sudden death during coitus has low incidence rates. When
it occurs while having extramarital sexual activity, a thorough
study of the cause, manner and circumstances of death is
required.
Sudden death during coitus has low incidence rates. When
it occurs while having extramarital sexual activity, a thorough
study of the cause, manner and circumstances of death is
required.
Case Report
A 59 year old caucasian male died after having sex
with a prostitute. The medical antecedents were type 2
(non-insulin-dependent) diabetes mellitus and smoking cessation one week
before. At the scenario there was not evidence of or related to
criminal activity and the forensic autopsy was carried out.
The corpse was 1.88 m tall, weighed 95 Kg and body mass index 26.87 Kg/m2
(overweight). The internal findings were: chronic obstructive pulmonary
disease, generalized atherosclerosis, cardiac tamponade (250 cc of
hemopericardium accumulated) (Figure 1) associated with a myocardial
infarction and rupture of the left ventricle (Figures 2 & 3). There
was a narrowing of the lumen more than the 75% of the proximal portion
of the left anterior descending coronary artery almost immediately after
its origin.
The postmortem blood alcohol concentration was of 0.35 g/L and there was not evidence of other drugs.
The medicolegal autopsy reported a sudden death due
to hemopericardium tamponade associated with myocardial infarction and
coronary artery disease. As a comorbidities we considered the death was
related to overweight and type 2 diabetes.
There was no medical report of previous myocardial infarction of the deceased.
A 59 year old caucasian male died after having sex
with a prostitute. The medical antecedents were type 2
(non-insulin-dependent) diabetes mellitus and smoking cessation one week
before. At the scenario there was not evidence of or related to
criminal activity and the forensic autopsy was carried out.
The corpse was 1.88 m tall, weighed 95 Kg and body mass index 26.87 Kg/m2
(overweight). The internal findings were: chronic obstructive pulmonary
disease, generalized atherosclerosis, cardiac tamponade (250 cc of
hemopericardium accumulated) (Figure 1) associated with a myocardial
infarction and rupture of the left ventricle (Figures 2 & 3). There
was a narrowing of the lumen more than the 75% of the proximal portion
of the left anterior descending coronary artery almost immediately after
its origin.
The postmortem blood alcohol concentration was of 0.35 g/L and there was not evidence of other drugs.
The medicolegal autopsy reported a sudden death due
to hemopericardium tamponade associated with myocardial infarction and
coronary artery disease. As a comorbidities we considered the death was
related to overweight and type 2 diabetes.
There was no medical report of previous myocardial infarction of the deceased.
Discussion
Spanish legislation requires for every deceased a
certificate to be issued which is to be signed by the last attending
phyisician. In our case the physician was not asked to sign the death
certificate so the medicolegal autopsy was performed in our Medico Legal
Institute.
Sometimes sudden death is related to a myocardial
infarction during or after sexual intercourse. But how often does it
occur?. Case-crossover studies investigating the association between
episodic physical or sexual activity and myocardial infarction or sudden
cardiac death concluded that acute cardiac events were significantly
associated with episodic physical and sexual activity; and that this
association was attenuated among persons with high levels of habitual
physical activity [1]. Sudden death reported during sexual intercourse
has low incidence rates (0.6%–1.7%) [2-4]. Of the subjects who died
during coitus, 82% to 93% were men, and the majority (75%) were having
extramarital sexual activity, in most cases with a younger partner in an
unfamiliar setting and/or after excessive food and alcohol consumption
and/or Sildenafil ingestion [5].
Meta-analysis of 4 case-crossover studies, which
consisted of 50% to 74% males predominantly in their 50s and 60s, showed
that sexual activity was associated with a 2.70 increased relative risk
of myocardial infarction compared with periods of time when the
subjects were not engaged in sexual activity [6].
Spanish legislation requires for every deceased a
certificate to be issued which is to be signed by the last attending
phyisician. In our case the physician was not asked to sign the death
certificate so the medicolegal autopsy was performed in our Medico Legal
Institute.
Sometimes sudden death is related to a myocardial
infarction during or after sexual intercourse. But how often does it
occur?. Case-crossover studies investigating the association between
episodic physical or sexual activity and myocardial infarction or sudden
cardiac death concluded that acute cardiac events were significantly
associated with episodic physical and sexual activity; and that this
association was attenuated among persons with high levels of habitual
physical activity [1]. Sudden death reported during sexual intercourse
has low incidence rates (0.6%–1.7%) [2-4]. Of the subjects who died
during coitus, 82% to 93% were men, and the majority (75%) were having
extramarital sexual activity, in most cases with a younger partner in an
unfamiliar setting and/or after excessive food and alcohol consumption
and/or Sildenafil ingestion [5].
Meta-analysis of 4 case-crossover studies, which
consisted of 50% to 74% males predominantly in their 50s and 60s, showed
that sexual activity was associated with a 2.70 increased relative risk
of myocardial infarction compared with periods of time when the
subjects were not engaged in sexual activity [6].
Conclusion
In our case there was a rupture of the myocardium as
a complication of a transmural myocardial infarction. This is most
likely to occur in the first week between 3 to 5 days following the
initial event, when the myocardium is the softest.
The interview with the family, especially with the
wife, in cases like this is particularly embarrassing when information
about the circumstances of the death is required.
In our case there was a rupture of the myocardium as
a complication of a transmural myocardial infarction. This is most
likely to occur in the first week between 3 to 5 days following the
initial event, when the myocardium is the softest.
The interview with the family, especially with the
wife, in cases like this is particularly embarrassing when information
about the circumstances of the death is required.
Acknowledgement
The authors are deeply in debt to the Forensic Pathology Assistants and to Mr Eduard Aizpun for his lingustic support.
To know more about Journal of Cardiology Please
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The authors are deeply in debt to the Forensic Pathology Assistants and to Mr Eduard Aizpun for his lingustic support.
To know more about Journal of Cardiology Please
click on :
To know more about Open access Journals
Publishers Please click on : Juniper Publishers
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