Study on existence of inflammation in the myocardium in unequivocal acute traumatic deaths

Over-diagnosis of myocarditis is possible, where presence of scant/negligible inflammatory foci are interpreted as active myocarditis in autopsy cases. A Prospective descriptive study on 100 young healthy individuals who died of known sudden traumatic causes was performed to study the existence, frequency and severity of inflammatory foci in myocardium of a normal population who died suddenly of acute trauma, in order to develop an autopsy diagnostic criteria. Out of 100 hearts, 48 had scant inflammatory foci. Thirteen had mild inflammation and three with moderate inflammation. Presence of scant inflammation was significantly associated with the age of the individual (P = 0.0182). However, the presence or severity of inflammation did not show any significant association with the clinical symptoms (P = 0.4924), gross pathology (P = 0.3954) or weight of the heart (P = 0.3109). Presence of scant inflammation in the myocardium is a common occurrence and it may be an age related change, which cannot account for the cause of death. Much severe forms of myocarditis with no clinically apparent picture could exist among young individuals. Thus, in the absence of other causes of death, conclusion of myocarditis as a cause of death in these cases needs a careful evaluation of other positive signs. •Presence of scant inflammation in the myocardium is a common occurrence.•Scant inflammation, especially among individuals above 20 years of age, cannot be attributed as a cause of death.•Notable focal myocyte necrosis with inflammation could exist in hearts of the young with no clinicopathological picture.•Conclusion of myocarditis as a cause of death needs a holistic review without limiting to Dallas criteria.