Subendocardial haemorrhage in forensic pathology: Development mechanism

Subendocardial haemorrhage (SEH) represent medical entity where haemorrhage is seen in layer beneath endocardium. Those lesions are most common in the ventricle of the left heart. They could be primary, connected to direct heart trauma; however, in forensic medicine they are usually secondary, as indirect consequence of other body part injuries. Secondary could be due to shock as result of hypovolemia and hypoprefusion. In forensic pathology, as well in literature, these findings were described in cases of massive haemorrhage and life-threatening head injuries. Actually, in some authors reports SEH is more common finding in fatal haemorrhage than in cases of head injuries when analyzed separated, but when results are analyzed toghether, the SEH is the most common finding. By reviewing literature so far authors have provided two possible mechanisms of SEH development. First is referring to "cathecholamine theory" and implies that SEH is in fact a consequence of sudden increase of cathecholamine blood level. Second theory is mechanical, and says that SEH is forwarded by sudden blood drop in left ventricle. However, it is hard to evaluate in concrete case wich mechanism has been represented. Significance of SEH in forensic pathology could sometimes be great, but it must not be neglected how important this entity could be in clinical practice. Sometimes patients with fatal head injuries, and without any brain activity are potential organ donors. In cases of acute injury with onset catecholamine influx SEH can arise due to sympathetic stimulation. Heart with SEH cannot be an adequate transplantation graft.