Second opinion system for sudden cardiac death cases in forensic practice

Area of Science:

• Forensic Pathology
• Cardiovascular Pathology
• Sudden Cardiac Death

Background:

• Sudden cardiac death (SCD) is a significant cause of mortality globally, frequently linked to atherosclerotic coronary artery disease (CAD).
• Less common causes of SCD include cardiomyopathies, congenital heart defects, and genetic channelopathies.
• Forensic pathologists conduct autopsies for SCD, but diagnosing rarer conditions can be challenging.

Purpose of the Study:

• To provide recommendations for forensic pathologists regarding heart retention for expert consultation in cases of sudden cardiac death (SCD).
• To outline alternative procedures, including documentation and sampling, when heart retention is not feasible.
• To address the need for expert opinion, even in cases with a morphologically normal heart, to avoid overdiagnosis.

Main Methods:

• Review of current practices in forensic pathology for sudden cardiac death (SCD) examination.
• Development of guidelines for heart retention and referral to specialized centers.
• Establishment of protocols for photographic documentation and histological sampling when heart retention is not possible.

Main Results:

• Highlights the challenges in diagnosing non-CAD causes of sudden cardiac death (SCD) during routine forensic autopsies.
• Emphasizes the importance of referral to specialized centers for complex cases, particularly in young individuals.
• Proposes a standardized approach for documentation and sampling as an alternative to heart retention.

Conclusions:

• Expert consultation and specialized examination are crucial for accurate diagnosis of the diverse causes of sudden cardiac death (SCD).
• Clear guidelines are needed for forensic practice to ensure appropriate case selection for further investigation.
• Implementing these recommendations can improve the diagnostic accuracy of SCD and prevent misattributions of responsibility.