Abstract

RICO GARCIA, A.; GARCIA GALLARDO, P.A.; LUCENA ROMERO, J.  and  GARFIA GONZALEZ, A.. Sudden cardiac death in a schizophrenic patient: left ventricular  free wall rupture due to acute myocardial infarction: Case report and literature review. Cuad. med. forense [online]. 2002, n.30, pp.51-59. ISSN 1988-611X.

Psychiatric patients, mainly schizophrenics, have occasionally somatic symptoms that are difficult to interpret leading to errors in the differential diagnosis with an organic illness. In the case of the acute myocardial infarction, the diagnostic's mistake may be fatal with the logical medico-legal repercussions derived from this situation. In this paper we present the case of a patient with a mental disorder perfectly diagnosed and treated, (Paranoid Schizophrenia), associated with an ischemic cardiopathy which starts clinically with an acute myocardial infarction. However, the somatic symptoms where attributed to his mental disorder and no medical attention was demanded, leading to his sudden death. In the forensic autopsy a cardiac tamponade was found secondary to a left ventricular free wall rupture due to myocardial infarction. Medical literature about this complication of acute myocardial infarction is reviewed considering clinical aspects, frequency, risk factors and pathology. Medico-legal studies have shown that this complication is more frequent when the death occurs out-of-hospital as opposed of death occurring in-hospital.

Keywords : Acute myocardial infarction; myocardial rupture; forensic autopsy; mental disorder; co-morbidity.

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