Left ventricular non-compaction cardiomyopathy (LVNC) is a rare congenital cardiomyopathy, which is
characterized by hypertrabeculations and deep recesses of the left ventricle. A patient could be
asymptomatic or presented with common manifestations, including reduced systolic function, arrhythmia,
thromboembolic events and heart failure. The rarity of the condition as well as lack of proper assessment
has probably led to this condition to be largely underdiagnosed or unrecognized. A 23-year-old lady had
collapsed at home thirty one days after delivering her first child. She had a history of goitre diagnosed a
year ago and noted to be fairly well throughout the pregnancy. Post mortem findings showed increased
trabeculations of the left ventricle. Further history was obtained after the procedure, revealing symptoms
such as syncopal attacks and bilateral lower limb weakness dated back as far as five years prior to her
sudden demise. These features were in keeping with hypotension hypoperfusion effects resulted from
reduced systolic function and decreased ejection fraction, as a result of left ventricular dysfunction. While
LVNC remains a rare type of disease, we would like to highlight the importance of a good anamnesis. It may
help to uncover some uncommon pathology such as this heart disease, thus warranting an appropriate
cardiac imaging to be engaged to clinch the primary diagnosis.
Introduction: Data on prevalence of coronary atherosclerosis and coronary artery disease (CAD) in young sudden death autopsy cases in Malaysia are still scarce. Calcium scoring (CS) on Computed Tomography (CT) was suggested to be predictive for CAD; however the reports have been conflicting. Objectives: to investigate (i) the prevalence of young CAD in sudden death cases in a Malaysian population; (ii) the association between CT CS and CAD in such cases and correlation with age. Methods: Sudden death cases received at the National Institute of Forensic Medicine, Kuala Lumpur between September 2012 and December 2013 were recruited. The cases were divided into young [≤40] and old [>40 years old] age groups. Presence of CAD was recorded during autopsy. Results: A total of 155 cases was included; 64.5% of the subjects were below 40 years old. CAD was the cause of death of 34 [21.9%] cases; of these, young individuals comprise 47.1% of cases [n=16; 10.3% of total cases, 16% of young sudden death cases]. Both young and old subjects with CAD had lower CS compared to those without CAD [p
Sudden cardiac death in young adults may be associated with rare cardiomyopathies such as left ventricular noncompaction (LVNC) and arrhythmogenic right ventricular (ARVC) cardiomyopathies. LVNC is characterised by hypertrabeculations and deep recesses of the left ventricle. ARVC presents with thin myocardium as a result of extensive fibro-fatty infiltrations. In both conditions, death may be due to arrhythmia, thromboembolic events or heart failure. We report a case of a 21-year old athletic young man who collapsed at the futsal court right after the game. He was resuscitated but expired at the hospital after a brief admission. A week earlier, he had a similar episode of syncope and revived through cardio-pulmonary resuscitation at the site. Post mortem examination showed extensive acute myocardial infarction (AMI) involving the papillary muscles and the left ventricular wall. Features of LVNC were also observed. On top of that, the right ventricle showed patchy thin myocardium as the wall was largely comprised of fat. Histology examination confirmed the presence of AMI and massive fibro-fatty infiltrations of the right ventricle. This unfortunate young man had co-existing cardiomyopathies which is rare indeed. As he succumbed to AMI, this mechanism of death is also uncommonly associated with neither LVNC nor ARVC. In conclusion, young and physically active individuals may not be spared of sudden cardiac death. Mild and non-specific symptoms should not be taken lightly as it may be the subtle signs of cardiomyopathies.
Bone cement implantation syndrome (BCIS) is characterized by hypoxia, hypotension, cardiac arrhythmias, increased pulmonary vascular resistance and cardiac arrest. It is a known cause of morbidity and mortality in patients undergoing cemented orthopaedic surgeries. The rarity of the condition as well as absence of a proper definition has contributed to under-reporting of cases. We report a 59-year-old woman who sustained fracture of the neck of her left femur and underwent an elective hybrid total hip replacement surgery. She collapsed during surgery and was revived only to succumb to death twelve hours later. Post mortem findings showed multiorgan disseminated microembolization of bone marrow and amorphous cement material.