The pathological investigation of sudden cardiac death

Globally sudden cardiac death is one of the leading causes of death. Epidemiologists in many different countries have studied the changing incidence of sudden cardiac death, while cardiologists and geneticists have investigated relevant risk factors and potential preventative treatments, especially in patients with inherited diseases of cardiac muscle. For their part, 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 review, 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. The written report should conclude with a clear and concise clinico-pathological summary stating, in particular, whether family members should be referred for screening. 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, importantly, permit future trends in the patterns of disease that cause sudden death to be monitored.