Sudden death due to isolated right ventricular infarction: a case report

Introduction: Isolated right ventricular infarction (RVI) is a rare phenomenon associated with atherosclerotic disease of the acute marginal vessels or of a non-dominant right coronary artery. It may happen in the absence of coronary disease when substantial right ventricular hypertrophy is present. The prognosis is usually good, although sudden collapse can occur due to ventricular fibrillation, rupture of the right ventricular free wall, or a massive pulmonary embolism. In this report, a case of sudden death in a patient with an isolated RVI due to an acute thrombosis of a non-dominant right coronary artery is presented.

Methods: A 46-year-old man without previous cardiopulmonary disease died suddenly at home. A medicolegal autopsy was performed within 72 h in order to clarify the circumstances that suddenly led the man to an unexpected death. Samples were collected for histological, immunohistochemical, and toxicological examination.

Results: The postmortem investigation revealed central cyanosis, polyvisceral stasis, and pulmonary oedema. The macroscopic examination of the heart showed left and right ventricular hypertrophy. A fresh thrombus located in the right coronary artery accompanied by a haemorrhagic infiltration of the posterolateral right ventricular wall was found. Microscopic findings confirmed the observations from the autopsy and showed miliary necrosis of the right ventricular wall. Toxicology was negative for drugs and alcohol.

Conclusions: On the basis of morphologic and microscopic data, the cause of death was determined to be an isolated RVI. The autopsy findings of both right and left ventricular hypertrophy associated with a nondominant right coronary artery thrombosis were observed. In cases like this, the authors would like to underline the importance of a complete postmortem examination and a full pathological approach.