C Heart Attack (Myocardial Infarction)/ Heart Diseases 1993-2018 ,u ,p vkj lh % iPphl o’kZ&vla[; vk’kk,a Nhrc : Twenty Five Years-billion Hopes 17. Is it possible that the patient may remain asymptomatic before the heart attack? It is possible that the patient may remain asymptomatic and without any signi icant recognisable sign of coronary artery disease before presenting with acute myocardial infarction. This is also called silent MI (Myocardial Infarction) which may be commonly seen in diabetic patients. 18. 19. 20. Whether myocardial infarction could always be con irmed at autopsy? Identi iable signs of myocardial infarction may not be visible on autopsy as they may not be visible in a short span of time between appearance of event and the death. What is RHD? Whether patient may die due to RHD at young age? Rheumatic heart disease (RHD) usually appears in young age. Involvement of different heart valve is a late complication of RHD, possible complications of which could be heart failure. Whether the disease RHD may remain silent or undiagnosed? Patients with chronic MR (Mitral Regurgitation - back low of blood due to disturbed structure of valve) can remain asymptomatic for years. However, if the patient survives the acute episode or has slowly progressive worsening of MR, the left lower heart chamber is able to develop compensatory changes. Symptoms are therefore either absent or slowly progressive over many years. Symptoms may be dif icult to ascertain in patients who are sedentary. Even MS (Mitral stenosisnarrowing of valve) may remain silent for decades. The outcome after Mitral Valve surgery is poorer in patients with a preoperative ejection fraction of less than 60% than in those with higher ejection fractions. If severe pulmonary hypertension develops, average survival is less than 3 years. Appropriate diagnosis, management, and follow-up of these patients are imperative to reduce long-term morbidity and mortality. FORENSIC INVESTIGATION | 35