Cardiac and Natural Causes of Sudden Death

Abstract

In most jurisdictions of Western societies, sudden and unexpected deaths are mainly due to natural causes linked with heart diseases by an initiating factor triggering cardiac arrest. The aim is to provide a background of facts currently known or believed with a critical review to aid the reader in resolving cases for which he or she is responsible. In other words, we revisit pathologic findings versus etiopathogenetic hypotheses and theories and propose new ones substantiated by previously misinterpreted or ignored facts. In this article, detailed findings are presented along with overall interpretations in order to help the forensic pathologist in a court of law to act as interpreter of the sequence of events leading to death. Sudden death due to cardiovascular causes is uncommon among the young, yet we provide insight as to cause. The incidence of cardiovascular disease increases with increasing age, and, as indicated above, it is now the leading cause of morbidity and death in Western societies. In reaching conclusions, a forensic pathologist must correlate and discriminate between terminal events and pathological findings that denote preexisting cardiac disease. It is insufficient to rely upon the tendency to believe (erroneously) that current clinical imaging techniques are alone sufficient to provide evidence of the cause of a disease. Advances in technology will procure a histo‐ultrastructural view in living people. At present, however, the autopsy remains the gold standard, with the proviso that the diminishing requests for postmortem examination by clinicians may, in the future, confine autopsy investigation to forensic institutions. There is, therefore, a need to establish strict collaboration between clinicians and pathologists.