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 Table of Contents  
ORIGINAL ARTICLE
Year : 2014  |  Volume : 13  |  Issue : 1  |  Page : 30-33

Sudden deaths in hotels following sexual intercourse at south eastern Nigeria from 2010 to 2013


1 Department of Pathology and Forensic Medicine, University of Calabar Teaching Hospital, Calabar, Nigeria
2 Department of Anatomic Pathology/Haemato-Pathology, Federal Medical Centre, Umuahia, Nigeria

Date of Web Publication25-Aug-2014

Correspondence Address:
Dr. Martin Nnoli
Department of Pathology and Forensic Medicine, University of Calabar Teaching Hospital, Calabar
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2384-5589.139440

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  Abstract 

Aim/Objectives: This is to determine the actual cause of deaths of guests that walked in-to lodge in hotels in south eastern part of Nigeria. Materials and Methods: A sectional study of all reported deaths in hotels in Abia state, South Eastern Nigeria was undertaken. A total of seven (7) bodies were reported within the period of 2010-2013. All victims affected were males with an age range of 45-58 years and a mean age of 48.9 years. A detailed autopsy of all bodies was done at different time when they inquest (from coroner) was served by the law enforcement as the results of autopsies/court sermons kept intact. Results: All the bodies were seen to have died of cardiovascular-related disorder despite the ploy of report on the youngest of all-35 years that was said to have died in the swimming pool; we found out that he was already dead by the time the body was recovered from the pool. Conclusion: This shows that sexual activity is associated with augmented adrenergic stimulation that increases sympathetic output which resulted in increased heart rate with ventricular ectopic/fibrillation thus resulting to myocardiac infarction.

Keywords: Autopsy, myocardiac infarction, sexual intercourse, sudden death


How to cite this article:
Nnoli M, Charles NC, Omotoso AJ, Ogbonna NC. Sudden deaths in hotels following sexual intercourse at south eastern Nigeria from 2010 to 2013. Afr J Med Health Sci 2014;13:30-3

How to cite this URL:
Nnoli M, Charles NC, Omotoso AJ, Ogbonna NC. Sudden deaths in hotels following sexual intercourse at south eastern Nigeria from 2010 to 2013. Afr J Med Health Sci [serial online] 2014 [cited 2021 Mar 8];13:30-3. Available from: http://www.ajmhs.org/text.asp?2014/13/1/30/139440


  Introduction Top


Sudden death is a death occurring within 24 hours from the onset of symptoms, but this time is too long for many clinicians and pathologists, some of them only accept death within 1hour from the onset of illness as natural death. [1] Although extracardiac causes may be involved in this process, it is assumed that causes of sudden deaths are mainly related to cardiovascular events. [1] However, all deaths are classified into natural and unnatural; as this is based on cause of death. Death are said to be natural if it is caused by disease.

Life depends on functional integrity of cardiovascular system, respiratory, and nervous system. In most cases, a failure of any of this system will surely affect the other two resulting to death. Deaths from cardiovascular system is usually associated with coronary artery disease which can occur at anytime of the day or in any activity. [2] Intracranial bleed may be from congenital or acquired causes. The congenital one is due to a ruptured berry aneurysm which is a sac like outpouching of the main cerebral arteries at their points of bifurcation or anastomosis in the circle of Willis located at the base of the brain. [3] This is berry aneurysm (named after the shape of the lesion) also called saccular aneurysm. The fusiform or dissecting type of aneurysm is mostly acquired. They result from arteriosclerosis, congenital arteriopathy, or traumatic dissection. [4],[5],[6] Other causes such as; hypertension, tobacco use, gender and age are some of the known predisposing factors to aneurysm formation. [7],[8]

In most of the cardiovascular-associated deaths, the individual might be sleeping or participating in strenuous activity like in majority of our cases;- all had a partner at one time or the other while in the hotel room. However, their guests (females) eloped at early hours of the next day some moments after they notice the death of their male partners.

Severe climatic conditions such as heat and cold may stress the heart, predisposing it to angina attacks and sudden deaths. [9] There is no doubt strenuous activity predisposes to sudden death. [10],[11],[12] In cases of aged 35 years and above like in most of our cases, coronary atherosclerosis is the most common cause of death in exercise-related deaths. In younger age groups, the most frequent causes are hypertrophic cardiomyopathy and congenital anomalies of coronary arteries. [13] Most common anomaly is anomalous origin of the coronary artery from the right sinus of valsalva.


  Summary of Cases Top


The seven autopsies were done at different times within the study period of 2010-2013. However, all results were kept intact. The respective ages were as follows: A:58 years, B:47 years, C:45 years, D:53years, E:49years, F:55 years, G:35 years. One significant thing about all the cases was that they all lodged into the hotel (guest rooms) with a lady partner. The crime scene showed used latex structures with dried liquid-suspected to be semen in most of their rooms. Also, the management of the hotel affirmed the sudden disappearance of their partners at early morning hence could not give account of their where about. These probably suggested the vulnerability of all the male partners in one time or the other within the study period.

In all cases, the physical examination showed in few cases mild cyanosis otherwise nothing spectacular except for the youngest aged 35 years that had features of water woman's appearance with clutched arms. This is sequel to recovery of the body at the swimming pool of the hotel.


  Heart Top


They heart showed the major pathological findings in all the cases autopsied. They all had features suggestive of hypertension with gross enlargement of the heart above normal range of 300-350 grams. All the hearts weighed approximately between 450 - and 720-grams [Figure 1], [Figure 2] and [Figure 3]. This is seen to be above the normal weight for males. The hearts markings too were all affected as patients A, C, F, G had left ventricular wall thickness of 2.2, 1.7, 1.6, and 2.8cm, respectively, with pointing bulbous chordea teindinea and hypertrophy of the ventricular walls [Figure 4]. The valves were all fibrotic, hard with multiple artheriomatous plaques on the great vessels. There are also patchy pale brick colouration of serial sections of the myocardial wall pointing to some degree of myocardial infarction.
Figure 1: Cardiomegaly

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Figure 2: Prominent trabaeculae muscles

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Figure 3: Cardiomegaly

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Figure 4: Left ventricular hypertrophy

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  Lungs Top


They showed mild to moderate pulmonary edema as they were wet, shinning, and heavy. Cut sections showed frothy fluid exudates with deep red surfaces.


  Brain Top


All showed moderate to severe cerebral edema.


  Kidneys Top


Kidneys showed flea bitten appearance suggesting accelerated (malignant) hypertension in most of them and a few showed distinct cortico-medullary differentiation suggesting shocked kidneys seen in [Figure 5].
Figure 5: Marked corticomedullary differentiation

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The patient B, D, and E all had major pathology on the heart. All had gross cardiomegaly as respective heart weighed 530, 650, and 720-grams (normal heart weighed 350-grams), respectively. There is massive epicardial fat on the surfaces. Cut sections showed gross biventricular wall thickness of 1.2-cm and 2.3-cm for both right and left ventricular wall thickness (normal upper limit 0.6-cm and 1.5-cm), respectively. The whole wall surfaces show gross pale brick color.

In all the seven cases seen within the study period there were features of hypertension with acute myocardial infarction ([Figure 2] pointer)-which might have resulted from acute exacerbation of the pre-existing coronary atherosclerosis following such strenuous exercise as they could have involved themselves at different time of their deaths.


  Discussion Top


It is imperative to note that deaths occurring in hotels in most places are never reported; more-so in developing nation as mine hence there is no verifiable statistics about deaths in hotels. This is also the case of Russe et al., that only few cases were reported in their study as most cases are unreported. [14]

Dimaio et al.; showed that significant number of individuals who die suddenly and unexpectedly with history of hypertension have only left ventricular hypertrophy with or without severe atherosclerotic involvement of coronary arteries. Few others deaths result from cardiac arrhythmias with history of hypertension but no gross changes of hypertension in their kidneys; such as fine granularity of the cortical surfaces. This is equally seen in our study as there are features of hypertension on the heart with same seen in the kidneys.

Sudden death is now currently said to be natural unexpected death occurring within an hour of new symptoms. Previous studies focused on cardiac causes as most cases involved coronary artery disease. Though this is the leading cause of sudden death, the exact incidence of other causes is not well established because in most nations they are not autopsied.

It is important to note that sudden death could occur at rest and during exercise as some lethal arrhythmias are triggered by catecholamine during stressful activity hence type of drug taken which may link to the cause of sudden death. [15]

Trumatic asphyxia in a folding bunk bed has been found to cause sudden death in some parts of Europe like Spain. This is always the cause of death after a heavy alcoholic intoxicated individual in hotels in these places. [16] In our own environment and other developing nation this is absolutely lacking.

The guest could have also died as a result of postural or abnormal position compromising process of respiration. There are obvious marked congestions of face and petechial hemorrhages on the conjunctiva though after exclusion of other causes. In our study, these features are absent in all cases seen. [17]


  Limitation of Study Top


We could not do any toxicology as the facilities for assay were not available. That could have shown other causes that may have contributed to sudden death in these subjects.


  Conclusion Top


In all our cases there was involvement of cardiovascular disease, this was the experience of study by Vincent Dimaio in his studies. It is noted that acute cardiac failure seen in our study is mostly likely due to ventricular tachycardia which often progresses to ventricular fibrillation in about 80% of cases. The remaining 20% deaths may have been due to asystole or Brady-arrhythmias.

Severe climatic changes as heat/cold may affect the heart predisposing it to angina attacks and sudden deaths. There is no doubt that excessive physical activity could predispose to sudden death. [10],[11],[12] This is because the most common cause of death in exercise related death above the age of 35 years is coronary atherosclerosis. [10]

Sudden death following sexual activity in our cases is mainly caused by re-infarction or acute myocardial infarction in males. This is equally seen in a German case report where women constituted only a small percentage of the fatalities of the cases, only one occurred in a car. [18] In a study by Parzellar et al., in Germany, they reported that the main cause of death during sexual activity is re-infarction or acute myocardial infarction (55%) followed by coronary artery-related disease (29%) with 9% having left ventricular hypertrophy.

Finally, sexual activity is associated with augumented adrenergic stimulation which increases sympathetic output and subsequently increases heart rate and this may be the cause of increasing ventricular ectopic activity and lowered ventricular fibrillation threshold. This may have played a role in ventricular arrhythmias associated with myocardial infarction. [19]

 
  References Top

1.Ozdemir B, Celbis O, Onal R, Mizrak B, Karakoc Y. Multiple organ pathologies underlying in sudden natural deaths. Med Sci 2012;1:13-26.  Back to cited text no. 1
    
2.Dimaio V, Dimaio D. Deaths due to natural disease. Textbook of Forensic Pathology, 2 nd ed.; 2001. p. 43.  Back to cited text no. 2
    
3.International Study of Unruptured intracranial aneurysms investigators. Unruptured intracranial aneurysms-risk of ruptured and risks of surgical intervention. International Study of unruptured intracranial aneurysm investigators. N Engl J Med 1988;399:1725-33.  Back to cited text no. 3
    
4.Nakayama Y, Tanaka A, Kumate S, Tomonaga M, Takebayashi S. Giant Fusiform aneurysm of basilar artery: Consideration of its Pathogenesis. Surg Neurol 1999;51:140-5.  Back to cited text no. 4
    
5.Anson JA, Lawton MT, Spetzler RF. Characteristics and surgical treatment of dolichoectatic and fusiform aneurysms. J Neurosurg 1996;84:185-93.  Back to cited text no. 5
    
6.Drake CG, Peerless SJ. Giant Fusiform intracranial aneurysms: Review of 120 patients treated surgically from 1965-1992. J Neurosurg 1997;87:141-62.  Back to cited text no. 6
    
7.Connolly ES Jr, Choudhri TF, Mack WJ, Mocco J, Spinks TJ, Slosberg J et al. Influence of smoking, Hypertension and sex on the phenotypic expression of familial intracranial aneurysms in siblings. Neurosurgery 2001;48:64-9.  Back to cited text no. 7
    
8.Mostafazadeh B, Farzaneh Sheikh E, Afsharian Shishvan T, Seraji FN, Salmasian H. The incidence of berry aneurysms in the Iranian Population: An autopsy Study. Turk Neurosurg 2008;18:228-31.  Back to cited text no. 8
    
9.Kavanagh T. A cold weather "jogging mask" for angina Patients. Can Med Assoc J 1970;103:1290-1.  Back to cited text no. 9
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10.Caplan NL, Gleim GW., Exercise and Sudden Cardiac death. Am J Heart 1988;15:207-12.  Back to cited text no. 10
    
11.Mittleman MA, Maclure M, Tofler GH, Sherwood JB, Goldberg RJ, Muller JE. Trigerring of acute Myocardial Infarction by heavy Physical exertion. N Engl J Med 1993;329:1677-83.  Back to cited text no. 11
    
12.Willich SN, Lewis M, Lowel H, Arntz HR, Schubert F, Schroder R. Physical Exertion as a trigger of acute myocardial infarction. N Engl J Med 1993;329:1684-90.  Back to cited text no. 12
    
13.Maron BJ. Cardiovascul ar risks to young Persons on the atheletic field. Ann Intern Med 1988;129:379-86.  Back to cited text no. 13
    
14.Risse M, Weilbacher N, Birngruber C, Verhoff MA. Deaths in hotels. Arch Kriminol 2001;225:188-94.  Back to cited text no. 14
    
15.de la Grandmaison GL. Is there Progress in the autopsy diagnosis of Sudden unexpected death in adults? Forensic Sci Int 2006;156:138-44.  Back to cited text no. 15
[PUBMED]    
16.Domenech MS, Alcazar HM, Pallares AA, Vicente IG, Garcia JC, Gutierrez CV, et al. The murderer is the bed: An Unusual case of death by traumatic asphyxia in a hotel folding bunk bed. Forensic Sci Int 2012:220:e1-4.   Back to cited text no. 16
    
17.Benomran FA, Hassan AL. An unusual accidental death from Positional asphyxia. Am J Forensic Med Pathol 2011;32:31-4.  Back to cited text no. 17
    
18.Parzellar M, Raschka C, Pratzka H. Sudden Cardiovascular death in correlation with sexual activity results of medico-legal PM study from 1972-1988. Eur Heart J 2001;22:610-1.  Back to cited text no. 18
    
19.Safi AM, Rachko M, Yeshou D, Stein RA. Sexual activity as a trigger for ventricular Tachycardia in patient with implantable cardioverter defibrillator. Arch Behav 2002;31:295-9.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]



 

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  In this article
   Abstract
  Introduction
  Summary of Cases
  Heart
  Lungs
  Brain
  Kidneys
  Discussion
  Limitation of Study
  Conclusion
   References
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