Features of Karoshi death:
(1) recent history of excessive work or work-related pressures
(2) unexpected death, typically preceded by acute myocardial infarction or stroke
Risk factors associated with Karoshi death:
(1) high number of overtime hours (or total hours worked per week)
(2) working night shift
(3) working on holidays
(4) starting a new job with no family or social support
(5) signs and symptoms of burnout
(6) high level of stress (typically work-related but other sources of stress may be present)
The diagnosis is largely one of exclusion. It is important to exclude:
(1) premature coronary artery disease
(2) cardiac anomaly (affecting valve, coronary artery, conduction system, etc)
(3) stimulant abuse (cocaine, amphetamine, etc)
(4) malignant hypertension
(5) alcohol misuse
(6) cerebral aneurysm
(7) other causes of sudden death (asthma, anaphylaxis, seizure disorder)
(8) suicide
(9) toxic exposure
