European Journal of Cardiovascular Medicine

The definition of a sudden death varies according to authority and convention. The World Health Organization (WHO) definition is of natural death within 24 hours from the onset of symptoms, but this is much too long for many clinicians and pathologists; some will only accept death within 1 hour from the onset of illness. We have to also bear in mind that a death may appear sudden and unexpected to an outsider but need not have been so from the point of the pathological disease process. The deceased have been symptomless and utterly unaware of his chronic disease or he may have had symptoms but interpreted them as harmless. Also, fear, lack of human contact or his own disposition may have prevented him mentioning symptoms to anyone, including a doctor [1].

In sudden death, the immediate cause is almost always to be found in the cardiovascular system, even though topographically the lesion is not in the heart or great vessels. Massive cerebral haemorrhage, subarachnoid bleeding, ruptured ectopic pregnancy, haemoptysis, haematemesis and pulmonary embolism, for example, join with heart disease and aortic aneurysms to contribute most of the vascular system reasons for sudden, unexpected death [1].

The study of SNDs is crucial for understanding the prevalence and causes of these untimely deaths, which can have significant implications for public health, particularly in terms of prevention and intervention strategies. Sudden deaths may occur in older individuals under circumstances that typically do not raise suspicion. However, when such deaths happen in younger individuals, they are more likely to prompt concerns [2].

In these situations, an autopsy is strongly recommended. A medical officer should not issue a death certificate for a sudden death without conducting an autopsy, if the death appears unexpected or unusual, the case should be reported to the appropriate legal authorities for further investigation.[2].

Aims & Objectives:  To obtain and compare the information on causes and incidence of sudden death due to all causes in all age groups in cases of medico-legal autopsy.

Present study was done in a retrospective manner at the department of Forensic medicine, Assam medical College & hospital, Dibrugarh, Assam for a period of two years from January 2023 to December 2024. A total of 3623 numbers of post-mortem examinations was done during these periods out of which 205 cases were found to be sudden natural deaths (SND) cases recorded.

Collection of data

The primary data in each case is collected from the police inquest along with the statements of relatives taken by investigating officers and autopsy surgeon. Findings from a thorough external and internal examination of the corpse were studied in detail. Postmortem reports were studied in all cases. These cases were studied by applying different criteria, like methods of age, gender, ethnicity, marital status, and identified cause of death, were collected from forensic autopsy records.

Inclusion

1. All cases where postmortem findings suggest it to be a case of natural death.
2. Patients who were initially admitted in Medicine/Surgery casualty ward and then died within 24 hours of admission there with no history of injury, poisoning and terminal or chronic illness.
3. All age groups from both sexes.

Exclusion

1. Patients who were initially admitted in Medicine/Surgery casualty ward and then died within 24 hours of admission there with history of injury, poisoning and terminal illness.
2. Deaths after 24 hours of the onset of symptoms.

A total of 205 (5.65%) sudden death cases were reported, with 160 (78.04%) being male and 45 (21.95%) being female. The age range of 41–60 years had the highest number of sudden deaths, with 103 (50.24.%) cases.

TABLES

Table 1: Gender wise distribution of Sudden Death.

Males (78.04%) experienced a greater impact than females (21.95%), possibly due to increased exposure to risk factors including smoking, stress, and sedentary lifestyles. This gender difference was evident across all age groups, highlighting the necessity for health interventions targeted specifically at males.

Table 2: Age wise distribution of sudden death cases.

Individuals in the middle-aged category (41–60 years) represented 50.24% of deaths, underscoring the susceptibility of this working-age demographic. The elderly population (≥61 years) accounted for 20.48%, frequently associated with winter conditions and chronic diseases, whereas younger individuals (≤20 years) experienced the lowest mortality rate at 10.73%, primarily attributed to congenital and undiagnosed health issues.

Table 3: Distribution of Sudden Natural Deaths by Marital Status

Table 4: Causes of Death in Sudden Natural Deaths

Cardiovascular diseases accounted for 53.65% of deaths, making them the most prevalent cause, especially among males aged 41 to 60 years. Respiratory disorders, which represented 17.56%, were the second most common cause of death, Neurological conditions, comprising 12.68% of fatalities, including strokes and brain haemorrhages, had a disproportionate impact on the elderly population. Gastrointestinal disorders, along with various other causes, collectively made up 16.09% of the total deaths.

Maximum deaths were due to coronary artery disease (CAD) 98 cases (47.80 %), followed by lobar pneumonia 19 cases (9.21%).

Fig.1. Myocardial Infarction

Fig.2. 850 grams of Heart in case of sudden cardiac arrest.

During present study, out of 3623 medico-legal autopsies performed, in 205 cases (5.65 %) cause of death was sudden natural. This finding is similar with Sanjay Gupta et al4 and also with the findings of Naresh P. Zanjad and S. D. Nanadkar 4 Higher incidences of natural deaths were reported by Kumar et al [7]1(18. 8%) and Iver Nordrum et al [05] (27.8%) in overseas studies.

In the present study total 205 cases were studied out of which 160(78.04%) were male and 45 (21.95%) were female. This is consistent with the finding of Reddy P [2]. This finding is not consistent with the finding of Escoffery C.T and Shirley S.E, 9 this might be due to difference in geographic distribution of disease pattern, lifestyle and dietary habits.

In our study, the majority of sudden natural deaths (50.73%) occurred in individuals aged 41–60 years, Similar to the finding Mukhopadhyay S et al [10] in their 72 (37.5%) in the age group of 41 -60 years.  Kumar et al. [7] and Narsireddy et al. [8] reported the highest incidence of sudden natural deaths in the 41-50 age group. In contrast, Chaudhari V et al. [6] found that most common in the 51 – 60 age group, while Escoffery CT et al. [9] reported the highest occurrence in the 61 – 70 age group, which differs from the findings of the present study.

In our study, 66.34% of sudden natural deaths occurred among married individuals, suggesting that while marriage often provides social and emotional support, it does not fully mitigate health risks. Similarly, Mukhopadhyay S et al. [10], Chaudari VA et al. [11], Narsireddy R et al. [8] observed a high proportion of medicolegal cases among married individuals, reflecting their significant representation in the adult population.

Out of 205 cases of sudden natural death, diseases of cardiovascular system accounted for 53.65% of all sudden deaths, respiratory system diseases for 17.56%, central nervous system diseases for 12.68%, alimentary system diseases for 08.78% and genitourinary system diseases for 1% of deaths. The findings are more or less consistent with the findings of Apurba Nandy13. These findings in the present study are also nearly consistent with findings of K. S. Narayan Reddy and O. P. Murty14. These findings in the present study are also consistent with findings of Naresh P. Zanjad and S. D. Nanadkar4 and Sapate A et al 12. Similar rates of cardiovascular diseases have been reported as 56.4% by Di Maio et al. [15]

The research offers important insights into the trends and reasons behind sudden natural deaths (SNDs), underscoring the urgent necessity for focused preventive healthcare strategies.

Cardiovascular diseases were identified as the leading cause, representing 53.65% of the cases, especially in middle-aged men. This underscores the substantial impact of pre-existing medical conditions, lifestyle choices, and a lack of awareness regarding early warning signs.

Respiratory disorders (17.56%) and neurological conditions (12.68%) also significantly contributed, further emphasizing the need for proactive healthcare measures.

In order to alleviate the challenges posed by sudden deaths, it is essential to implement comprehensive strategies that encompass extensive cardiovascular screenings, public health education initiatives, and enhanced access to preventive healthcare services.

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