Coronary artery disease, sudden death and implications for forensic pathology practice

Coronary atherosclerosis is the leading cause of sudden death in developed nations. Triggers for sudden death include physical and emotional stress. At autopsy coronary artery atheroma is a common finding and may or may not be related to the cause of death. The forensic pathologist must consider the relative significant of disease, trauma and toxicological findings when determining the cause of death. This requires a consideration of evidence beyond the autopsy including the history, scene and ancillary investigations. Certain drugs including cocaine and methamphetamine are known to be atherogenic and acute and chronic use may be a factor in sudden death with underlying coronary artery atherosclerosis. Sudden death may also be associated with criminal conduct, when the scenario of “homicide by heart attack” needs to be considered. This review analyses forensic aspects of coronary artery disease.