Key result
Forensic investigation revealed that sudden death in a breath-holding diver was attributable to a lethal arrhythmia following myocyte disarray and hypoxia, rather than drowning.
Case Report (n=1)
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Highlights the importance of thorough forensic and histological investigation to identify underlying cardiac causes of sudden death in water, such as hypertrophic cardiomyopathy, rather than assuming drowning.
The authors report a case of sudden death in a breath-holding diver and highlight the forensic diagnostic difficulties in opining the cause of sudden death in water. The autopsy showed increased thickness of the left ventricular wall with a distinct pattern of concentric hypertrophy, evident particularly in the subaortic interventricular septum. Histological examination revealed diffuse interstitial fibrosis and associated findings of multifocal myocyte disarray especially evident in the subaortic interventricular septum. The analysis and discussion of this case made it possible to attribute sudden death to a lethal arrhythmia following myocyte disarray and hypoxia caused by breath-holding, the triggering factor of apnea. This case demonstrates the importance of a thorough forensic investigation, particularly in histological terms, in subjects found dead in water, in order to ascertain the real cause of death, which may not be always ascribable to drowning.
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Spagnolo et al. (2015) conducted a case report in Sudden death in water (n=1). Breath-holding (apnea) was evaluated on Cause of sudden death. Forensic investigation revealed that sudden death in a breath-holding diver was attributable to a lethal arrhythmia following myocyte disarray and hypoxia, rather than drowning.
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