Sudden adult death

Abstract

In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.

Natural and Undetermined Sudden Death: Value of Post-Mortem Genetic Investigation

“…In 56.87% of cases, death was labeled from coronary artery disease (CAD), either from evidence of myocardial infarction or from the identification of severe coronary stenosis, which induced ischemia-related arrhythmias [28]. This percentage is not much different than the one reported in other studies, which attributed nearly 40% of deaths to ischemic heart disease[33]. However, in other reports the percentage of CAD neared 80%.…”

Sudden adult death: An autopsy series of 534 cases with gender and control comparison

“…2,20 However, according to Langlois, 21 the degree of coronary atherosclerosis is not more severe in subjects who died from sudden cardiac death than in non-cardiac deaths. Information given by witnesses about the circumstances of the death can help for the post mortem diagnosis which can be difficult as a myocardial infarct is grossly detectable only after 12e24 h. 21 A large sampling of the heart for microscopic examination is required to increase the sensitivity of post mortem diagnosis. 2 Some causes of sudden cardiac death, classically reported in the literature, were not found in our series.…”

“…The rates reported in the literature vary between 4% and 10%. 21,23,24 According to Chugh et al, 18 origin of the sudden cardiac deaths remains undetermined in 50% of the women aged 35e44. This notion was not found in our series.…”

Sudden death due to acute adrenal crisis

“…In summary, it is important to conduct a comprehensive evaluation of all the macroscopic and histological observations in an autopsy case such as this [2,8,9]. The combination of characteristic postmortem findings and known preexisting conditions assisted in the determination of acute adrenal crisis as the cause of this sudden death.…”