Review
Sudden unexpected death from cardiac causes in Nigerians:: A review of 50 autopsied cases

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Abstract

Fifty cases of sudden and unexpected death from cardiac causes in individuals between the ages of 28 and 80 years are reviewed; the causes and circumstances of the deaths of these individuals are defined. 70% were males and 44% of the deaths occurred in the 41–50 years age group. Death was due to hypertensive heart disease in 82% of the cases and only 18% were previously diagnosed. Acute left ventricular failure was the commonest (68%) cause of death. Only 4% of the total died of acute myocardial infarction from coronary artery disease. The causes of sudden cardiac death in a developing country such as Nigeria, appears to be different to the pattern in Western countries.

Introduction

Sudden and unexpected death from cardiac causes continues to be a universal medico–legal and social problem to the doctor and the public at large. It is of continuing interest to the medical profession because of the challenges presented in its prediction and possible prevention. The law enforcement agencies investigate sudden unexpected deaths as homicides until a doctor's report confirm that the death is from natural causes, therefore a miscarriage of justice could sometimes occur. On the social level, it is a common cause of death in young highly productive adults with the attendant deleterious social and economic consequences on the family life.

In Western countries, ischaemic heart disease is the commonest cause of Sudden Cardiac Death [1]. Whereas, there have been few publications on the subject of sudden and unexpected deaths in Nigerians over the past several years 2, 3, there has been no comprehensive evaluation of a representative autopsied series of cases of sudden cardiac death from a large population.

In the present study 50 consecutive cases of sudden and unexpected deaths from cardiac causes autopsied at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria over a 5 year period were reviewed. The purpose of this study is to examine the circumstances of death and characterise the pathological basis of sudden cardiac death in Nigerians.

Section snippets

Materials and methods

The Coroners Law of Nigeria stipulates that all cases of sudden unexpected deaths must be reported to the Coroner who orders for an autopsy as part of the investigations of the circumstances of death. All the coroner's autopsies for the Ife-Ijesha zone is performed by pathologists at the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife. The Ife-Ijesha zone is a geographically well demarcated area in Osun State with an estimated population of about 782 207. This population is

Results

For the 5 year period from January 1991 to December 1995, a total of 1146 medicolegal autopsies were performed and there were 264 (22.5%) cases dying from natural causes that met the stipulated criteria of this study. Of these, 65 (22.5%) individuals died from cardiac causes. Only 50 of the latter had enough information regarding the circumstances of their deaths and pathological findings for review. The results are shown on Table 1.

Of the 50 cases, 35 (70%) were males and 15 (30%) were females

Discussion

This study has shown that sudden cardiac death is not an uncommon occurrence in Nigerians, especially in those who were apparently healthy, as found in 74% of the present study. Also the frequent occurrence of such fatality at the prime of life (66% of deaths occurred in the age range of 41–60 years), carries important implications from the public health viewpoint. The higher occurrence of such deaths in males (2:1 ratio) meant that such families were bereaved of their breadwinners with a

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