Subendocardial Hemorrhages in Forensic Pathology Autopsies

In a review of 1,034 consecutive forensic autopsies, there were 43 cases that had a distinct zone of subendocardial hemorrhage in the septal wall of the left ventricle. Cases in which there was direct injury to the heart or cardiac resuscitation were not counted. Of the 43 cases, 26 (60%) died of head injuries. Other causes of death were drug or chemical intoxication (14%) and abdominal injuries (12%); miscellaneous causes accounted for 14%. The time between injury and death varied considerably; in 13 cases (30%), the interval was < 1 h. Drugs and/or alcohol were not factors in the appearance of subendocardial hemorrhage, unless the drug itself caused death. Among the drug- or chemical-related fatalities, there were four cases of cocaine overdose with subendocardial hemorrhages. The results of this study are consistent with the hypothesis that cardiac lesions secondary to noncardiac injuries, particularly head injuries, are mediated by hypersecretion of catecholamines. Previous studies have shown significant cardiac decompensation due to noncardiac injuries, and it is likely that the cardiac lesions are part of the mechanism of death. The secondary cardiac lesions are also important for heart transplantation; catecholamine-mediated cardiac damage following head injury or shock may adversely affect performance of the transplant in the recipient.