Terror and extremely serious cardiovascular events: pathophysiology and medicolegal aspects

The impact of fright on critical cardiovascular events poses both a medical and legal problem. The author, a cardiologist and forensic expert, presents a study of 22 personal cases, evaluating the parameters and criteria for causality in these cases in relation to the association between major stress and major cardiovascular events. In this series, fright, of highly variable mechanism, is either isolated or associated with physical violence, which is inconsistent, but in all cases, this extreme stress, present in every case, is significant or perceived as such. The author analyzes the results of this observational study and introduces the concepts of "immediate death," within 10 minutes, and "late time", which can extend to several months; these two notions are fundamental in the discussion of causality. The pathophysiological factors underlying plaque rupture and potentially lethal arrhythmias, the two fundamental mechanisms triggering the accident, are also evaluated, along with their link to major stress. Finally, the analysis considers a medicolegal approach, leading to a discussion of the nature of the legal relationship between the two entities and allowing for a redefinition of the criteria for liability in this type of situation.