Sudden cardiac death and acute drunken state - autopsy study

Abstract

Introduction: Sudden natural death occurs unexpectedly in apparently healthy subjects, or in persons during an apparent benign phase in the course of disease. The most common cause is sudden cardiac death, which is sometimes the first and last manifestation of coronary heart disease. Alcohol directly influences excitation of myocytes, and therefore provokes arrhythmias and possibly, sudden cardiac death. Objective: To establish the frequency of sudden cardiac death in cases of acute alcohol intoxication, to determine blood alcohol concentration at the moment of death, and to determine frequency and level of ethanol intoxication in chronic alcohol abusers, as well as causes of sudden death in those cases. Method: Retrospective autopsy study was performed for a three-year-period. We analyzed cases of sudden natural death, in relation to age and gender, cause of death, and blood alcohol concentration (at least 0.5 g/L). We considered the person to be a chronic alcoholic abuser if gross examination of organs during autopsy showed changes typical for excessive and habitual alcohol consumption. Results: Our sample consisted of 997 cases: 720 men and 277 women, average age 62.0±15.2 years (min=11; max=98). Total of 753 of them died of sudden cardiac death: much more men (χ2=167.364; p=0.000), significantly younger than women (t=6.203; p=0.000). We determined acute alcohol intoxication in 73 persons - average blood alcohol concentration 1.85±1.01 g/L (min=0.55; max=3.85), and 61 of them died of cardiovascular diseases (χ2=236.781; df=5; p=0.000). Conclusion In our observed sample, not many persons were under acute alcohol intoxication (around 7%). Most commonly, they were chronic alcohol abusers who died due to exacerbation of chronic heart disease, mildly or moderately intoxicated - the younger, the drunker.