["Scared to death"--lethal cardiac arrhythmia caused by emotional stress].

Background: The cause of death in cases of sudden and unexpected death is determined by the forensic pathologist based on autopsy findings and toxicological analysis. In cases where no acute pathology or lethal injury are detected, and the circumstances surrounding the death were highly stressful or emotional, it is possible to attribute the inciting event as contributory to the death by causing cardiac dysrhythmia.

Method: Ten cases of sudden death related to stressful events were examined over a period of 2 years in the National Center of Forensic Pathology, all of which lacked findings of acute disease or serious injury. All suffered from variable degrees of chronic cardiac pathology, which probably contributed to dysrhythmia and death.

Discussion: Since the seventies of the previous century, forensic pathologists are entitled to determine mode of death as homicide or manslaughter, due to an acute cardiac event which cannot be diagnosed in an autopsy and which was a direct result of the circumstances prior to death. Later, these conditions were adjusted to include cases where no morphological findings were detected or when death is delayed by medical treatment. The physiological mechanisms responsible include an increase in catecholamine levels, an increase in blood pressure and platelet aggregation and a delay in cardiac and vascular recovery from stress.

Conclusions: Victims of sudden death caused by emotional stress, during a criminal act, usually have a background of chronic cardiac disease and/or are more susceptible physiologically to suffer an amplified reaction to stress. Legally, their deaths are considered as homicide or manslaughter.