The pathological investigation of sudden cardiac death

Sudden cardiac death is one of the leading causes of death in many different countries. Epidemiologists have refined criteria progressively for the definition of sudden death, while cardiologists have investigated relevant risk factors, especially in patients with cardiac failure and with inherited diseases of cardiac muscle. In contrast, pathologists are responsible for determining the precise cause of sudden death, but there is considerable variation in the way in which they approach this increasingly complex task. In this article, the methods that should be used in routine practice are described. The ideal autopsy involves careful scrutiny of the clinical records, a full macroscopic and microscopic examination, further laboratory tests and the formulation of a final diagnosis. In addition to a full written report, a synoptic proforma summary is desirable. If a uniform method of investigation is adopted, it will lead to improvements in standards of practice, allow meaningful comparisons between different communities and regions, and, most importantly, permit future trends in the patterns of disease that cause sudden death to be monitored.