State of the Art in Forensic Investigation of Sudden Cardiac Death

Abstract

The sudden death of a young person is a devastating event for both the family and community. Over the last decade, significant advances have been made in understanding both the clinical and genetic basis of sudden cardiac death. Many of the causes of sudden death are due to genetic heart disorders, which can lead to both structural (eg, hypertrophic cardiomyopathy) and arrhythmogenic abnormalities (eg, familial long QT syndrome, Brugada syndrome). Most commonly, sudden cardiac death can be the first presentation of an underlying heart problem, leaving the family at a loss as to why an otherwise healthy young person has died. Not only is this a tragic event for those involved, but it also presents a great challenge to the forensic pathologist involved in the management of the surviving family members. Evaluation of families requires a multidisciplinary approach, which should include cardiologists, a clinical geneticist, a genetic counselor, and the forensic pathologist directly involved in the sudden death case. This multifaceted cardiac genetic service is crucial in the evaluation and management of the clinical, genetic, psychological, and social complexities observed in families in which there has been a young sudden cardiac death. The present study will address the spectrum of structural substrates of cardiac sudden death with particular emphasis given to the possible role of forensic molecular biology techniques in identifying subtle or even merely functional disorders accounting for electrical instability.

Evaluation of postmortem MDCT and MDCT-angiography for the investigation of sudden cardiac death related to atherosclerotic coronary artery disease

“…According to the current recommendations in the field of autopsy practice and cardiovascular pathology [17,18,24,[39][40][41], histological examination of the myocardium should be performed in order to assess the time dependent histological patterns of ischemia. Some pathological findings, such as acute coronary occlusive thrombosis or myocardial rupture, are practically certain to represent the cause of death, whereas, the interpretation of chronic macroscopic findings, such as those described in ischemic heart disease, is more delicate.…”

Burden of Sudden Cardiac Death in Persons Aged 1 to 49 Years

“…[19][20][21][22][23] In the Data Supplement, we have described pathological criteria used for this study.…”

The role of clinical, genetic and segregation evaluation in sudden infant death

“…A complete autopsy examination was performed according to current international regulations for unexpected death [11][12][13]. All relatives included in our study were clinically evaluated at Hospital Josep Trueta of Girona (Girona, Spain), and Hospital Sant Joan de Déu (Barcelona, Spain).…”