Sudden natural death

Sudden natural death happens. It must be differentiated from other ways of dying (suicide, homicide, accidental).

By system

Respiratory

• Anaphylaxis.
• Asthma.
• Pulmonary embolism.

Cerebral

• SUDEP (sudden unexpected death in epilepsy).

Sudden cardiac death

Older

• Atherosclerotic heart disease (ASHD); AKA coronary artery disease (CAD).
• Hypertensive heart disease - a heart > ~400 g is considered good enough if nothing else is present.

Younger

• Arrhythmogenic right ventricular cardiomyopathy.
• Hypertrophic cardiomyopathy, e.g. hypertrophic obstructive cardiomyopathy (HOCM).

Notes:

• The mechanism is usually arrhythmia; this is usually not provable at autopsy.

Detailed cardiac

• ASHD.
• Cardiomyopathy.
  • Hypertrophic cardiomyopathy.
  • Arrhythmogenic right ventricular cardiomyopathy (ARVC).
  • Dilated cardiomyopathy (DCM).
• Lymphocytic myocarditis.
• Floppy mitral valve (MV).
• Aortic valve stenosis.
• Congenital cardiac abnormality.
• Coronary artery dissection.
• Aortic dissection.
• Arrhythmia.
  • Long QT syndrome.
  • Brugada syndrome.
  • Short QT syndrome.
  • Catecholaminergic polymorphic ventricular tachycardia (CPVT).
  • Anomalous conduction pathways.
  • Dysplasia of nodal arteries.
  • Atrioventricular node tumour.
  • Sodium channel disease.
  • Idiopathic ventricular fibrillation.

Post-mortem (molecular) testing for arrhythmias:

• CPVT.
• Sodium channel disease.
• Brugada syndrome.

By mechanism

Hemorrhagic

• Ruptured AAA.
• Peptic ulcer.
• Cerebral aneurysm.

See also

• Forensic pathology.
• Channelopathies.