Early repolarization, acute emotional stress and sudden death

We herein report the case of a 36-year-old man who died suddenly after a fight with another man. Forensic investigations included unenhanced computed tomography, postmortem angiography, autopsy, histology, neuropathology, toxicology, and biochemistry and allowed a traumatic cause of death to be excluded. An electrocardiogram recorded some years prior to death revealed the presence of an early repolarization pattern. Based on the results of all investigations, the cause of death was determined to be cardiac arrhythmia and cardiac arrest during an emotionally stressful event associated with physical assault. Direct third party involvement, however, was excluded, and the manner of death was listed as natural. The case was not pursued any further by the public prosecutor.

Homicide by fright: the intersection of cardiology and criminal law

The prevailing lay wisdom associates emotional stress with sudden death, and recent medical reports have linked massive catecholamine surges with demonstrable cardiac dysfunction that can be either reversible or fatal. This association does not strictly prove causality, and the question remains open for additional scientific investigation. From the legal viewpoint, however, the issue has been resolved, and case law clearly holds that sudden emotional stress can cause death. More significantly, case law also holds that if the sudden emotional stress is caused by criminal conduct, the resulting death of a victim of the criminal conduct can be prosecuted as homicide. Cardiologists are often called to testify in such circumstances. In the present study, we have reviewed 8 legal cases that are the basis of current opinions in these matters. These legal principles can be summarized as follows: emotional stress is sufficient, and physical abuse is not required for conviction; a time-lapse between the induction of emotional stress and death does not necessarily mitigate the charge of homicide; the criminal act must be the proximate cause of the victim's death; however, the accused does not always need to be physically present to commit the crime. In conclusion, although the pathophysiology of sudden death associated with massive emotional stress has not been fully elucidated from a scientific viewpoint, in the legal system, the association can be causative and can be the basis for a criminal prosecution. Cardiologists may be called on to provide expert opinions in the prosecution of these cases.