Sudden unexpected cardiac death--a practical approach to the forensic problem.

Area of Science:

• Cardiovascular Pathology
• Forensic Pathology
• Sudden Cardiac Death Etiology

Background:

• Sudden cardiac death (SCD) is a significant cause of mortality, often attributed to underlying cardiac conditions.
• Pathological examination is crucial for determining the cause of SCD, distinguishing between ischaemic and non-ischaemic heart disease.
• Identifying the specific etiology of SCD, especially in cases with a morphologically normal heart, presents diagnostic challenges.

Purpose of the Study:

• To review the pathological findings associated with sudden cardiac death.
• To categorize the causes of SCD, including ischaemic and non-ischaemic heart disease.
• To discuss the diagnostic challenges faced by pathologists in determining SCD etiology.

Main Methods:

• Pathological examination of hearts from sudden cardiac death cases.
• Analysis of coronary artery stenosis severity and presence of thrombosis.
• Review of non-ischaemic cardiac conditions and histological examination of myocardium and conduction system.
• Consideration of clinical history, family history, and electrocardiograms (ECGs).

Main Results:

• Ischaemic heart disease is the most frequent cause of SCD, with 85% stenosis in at least one coronary artery area being a significant indicator.
• One-third of ischaemic SCD cases involve recent coronary artery thrombosis.
• Predominant non-ischaemic causes include severe left ventricular (LV) hypertrophy, hypertrophic obstructive cardiomyopathy, and prolapsing mitral valve syndrome.
• In cases with a morphologically normal heart, cardiac arrhythmia is often presumed based on ECGs, family history, and histology.

Conclusions:

• Sudden cardiac death can be attributed to identifiable pathological findings, primarily ischaemic heart disease or specific non-ischaemic cardiac conditions.
• The degree of coronary artery stenosis is a critical factor in diagnosing ischaemic SCD.
• When the heart appears normal, further investigation including histology and genetic factors may be necessary to ascertain the cause, often pointing towards cardiac arrhythmia.