The Advancement of Postmortem Investigations in Sudden Cardiac Death

Abstract

Sudden cardiac death (SCD) is a major public health issue accounting for 15-20% of all-cause deaths. Several pathologies have been associated with sudden cardiac arrest. Clinical autopsies have always contributed to invention of novel strategies for SCD prevention. One of the serious challenges that pathologists are facing is the significant decline of the overall autopsy rate. Many reasons have been associated with this change, most importantly, the evolution process in the postmortem investigation tools. However, cardiologists seem unsatisfied with the new non-invasive imaging techniques and still believe in the traditional autopsy as a gold standard in diagnosis of cardiovascular diseases. In this chapter, we focused on the importance of autopsy in the prevention of SCD by shedding a light on guidelines of minimum requirement for routine autopsy investigation of SCD (including macroscopic, histological, toxicological and molecular examination). We also gave insight into the new radiological techniques, their advantages and related diagnostic pitfalls as compared to that of conventional autopsy. Thus, providing a comprehensive understanding on the advancement of postmortem examination will help improve the minimum standards of routine autopsy practice, develop new guidelines for radiological examination and prevent the growing heterogeneity of the pathologies underlying SCD.

From Death to Life/Back to the Future: Detailed Premorbid Clinical and Family History Can Save Lives and Address the Final Diagnosis in Sudden Unexplained Deaths With Negative Autopsy

“…1 In forensic medicine, 5% to 10% of all sudden death cases remain unexplained after routine postmortem autopsy and conventional investigations, 2 with no definite cardiac etiology identified after gross and microscopic inspection of the heart. 3 These are called sudden unexplained death (SUD) cases.…”

“…Sudden cardiac death (SCD) is one of the major causes of mortality worldwide and is responsible for a large proportion of sudden deaths in young individuals 1 . In forensic medicine, 5% to 10% of all sudden death cases remain unexplained after routine postmortem autopsy and conventional investigations, 2 with no definite cardiac etiology identified after gross and microscopic inspection of the heart 3 . These are called sudden unexplained death (SUD) cases.…”