Acute myocardial ischaemia presenting as sudden death in the Lothian and Borders regions of Scotland, 1987 and 1997.
OBJECTIVE
To profile deaths from acute myocardial ischaemia presenting as sudden unexpected death in the years 1987 and 1997, and to review the diagnosis of those patients who sought medical attention.


METHODS
A retrospective study using data obtained from autopsy and police reports held in the Forensic Medicine Unit of the University of Edinburgh.


RESULTS
Cardiovascular pathology was present in a significant proportion of cases. Clinically 'silent' events presenting as a sudden, unexpected death were common, comprising more than one-half of the events observed in 1987 and one-third of those in 1997. For symptomatic cases, respiratory and upper gastrointestinal symptoms were the most common presentation. The majority of patients seeking medical advice were misdiagnosed as either having a chest infection or indigestion.


CONCLUSIONS
Doctors in the primary care setting should include acute myocardial ischaemia as a possible differential diagnosis of a number of symptoms which initially do not suggest a myocardial origin.
Gregoriades
M L
ML
Regius Professor of Forensic Medicine, Forensic Medicine Unit, University of Edinburgh Medical School, Teviot Place, Edinburgh EH8 9AG, UK.
Squires
T J
TJ
Busuttil
A
A