Blunt chest trauma-induced myocardial infarction: a case of sudden death by homicide

Blunt cardiac injuries, which are typically the result of blunt chest trauma, are not particularly significant clinically. It is vital never to underestimate blunt chest injuries, especially when they occur in the anterior thoracic area. Blunt trauma to the chest is one of the rarest causative factors of myocardial infarction (MI). Blunt cardiac injury encompasses different medical emergency conditions such as gradual damage to the myocardium leading to myocardial ischemia, injuries to the great vessels of the heart, pericardial tamponade, septum or wall ruptures, pump failure, conduction abnormalities, and atrial and ventricular fibrillations. The most common cause of blunt chest trauma is a road traffic accident (RTA), followed by a sports injury. Mostly blunt trauma chest injuries occur below the age group of 45 years. A 45-year-old male with a history of physical assault was brought to the emergency department by his neighbor. He was allegedly kicked by his relative over the chest during an altercation sustained blunt-force trauma to the chest and collapsed immediately. On admission, he was given cardiopulmonary resuscitation and declared dead. On autopsy, there were no signs suggestive of external injury or any shoeprints/footprints on the chest. On histopathological examination, a diffuse area of discoloration consistent with an extensive myocardial infarction was noted. Old healed infarcts were seen in the free wall of the left ventricle, left posterior papillary muscle, and left apex. The coronaries showed atheromatous plaque with lumen narrowing and focal calcification. It is the task of the forensic pathologist to ascertain and record evidence as to whether the myocardial infarction was caused by the alleged blunt trauma to the chest during the autopsy. This is important as it will determine the type of prosecution the accused is likely to be charged with and the extent of the punishment that he will likely receive under the Indian Penal Code.