A 62-year-old man, a chronic heart patient, was attacked by two central Asian shepherd dogs in front of the family home. The dogs are kept in a kennel, in one of the neighboring yard. Unfortunately, they managed to escape. During the fight with the dogs, which lasted a few minutes, this man suffered multiple bite wounds on his neck, left shoulder, and extremities. There were superficial bites, bruises, and abrasions, which individually and collectively had the properties of light bodily injury (Figs. 1 and 2). Shortly after surviving the attack, the patient received urgent medical care and was transported to a nearby hospital. During the diagnostic examination of the patient, there was a sudden deterioration of his health state with a ventricular fibrillation, which requested an emergency transport to the intensive care unit, where he was successfully reanimated. Then, he was transferred to the Department of Cardiology in order to perform the percutaneous coronary intervention (Figs. 3 and 4), during which he again had a ventricular fibrillation, which was successfully converted. Upon leaving the catheterization room, there has been another episode of the cardiac event—ventricular fibrillation, followed by asystole. Despite the CPR measures taken, the patient died with the diagnosis of acute myocardial infarction, two and a half hours after experiencing an extreme physical and mental stress—the attack of large sheep dogs.
During the autopsy, we found superficial wounds on the neck, left shoulder, and extremities, but only on the skin and subcutaneous soft tissue, which could not endanger the life of the injured. The heart was enlarged, weighing 430 g, with thick walls, in the area of the left chamber up to 1.8 cm, and in the area of the right ventricle up to 0.9 cm. In the region of the apex and the diaphragmatic wall of the left ventricle, areas of myocardial scar tissue mixed with fresh bleeding were found. Coronary arteries had sclerotic changed walls and narrowed lumens up to 80%. In the initial part of the sclerotic changed interventricular branch of the left coronary artery, we found a placed stent. Histopathological analysis showed a pronounced atherosclerosis of the coronary arteries, myocardial hypertrophy with fibrolipomatosis, coagulative necrosis with dense infiltration of polymorphonuclear leukocytes and myocardial scarring from previous infarction (Fig. 5).
Relevant medical history: the patient had a chronic cardiomyopathy, suffered from high blood pressure, and 3 months before this event he was hospitalized at the Clinic for Cardiology due to myocardial infarction.
The immediate cause of death was acute myocardial reinfarction, on the ground of an existing disease of the heart muscle.