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Sudden cardiac death at autopsy

  • Topic

The autopsy of a sudden cardiac death examines the heart systematically to find the cause and to tell whether the family needs screening.

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What it is

Sudden cardiac death is the most common of the sudden natural deaths. Its autopsy follows a protocol: heart weight and measurements related to body height and weight, examination of the coronary arteries with serial transverse cuts, slices of the myocardium, examination of the valves and aorta, histology, toxicology and samples for genetics. The European cardiovascular pathology guidelines grade each finding as a certain, highly probable or uncertain cause. Over 35 years of age coronary disease dominates; in the young, cardiomyopathies, myocarditis, coronary anomalies and channelopathies. In Colombia and other parts of Latin America, Chagas cardiomyopathy must be considered: sudden death is its leading cause of death and can be its first manifestation.

Key facts

  • Acute coronary occlusion or acute myocardial infarction is graded as a certain cause.
  • A plaque with more than 75 % stenosis and no thrombus is graded as a highly probable, not certain, cause; it is weighed against the history.
  • If the heart is normal grossly and on histology and toxicology is negative, the term is sudden arrhythmic death syndrome.
  • Chagas: cardiomyopathy with fibrosis and sometimes an apical aneurysm; death is usually from ventricular fibrillation.
  • The protocol includes other causes to look for: aortic dissection or rupture with haemopericardium, and massive pulmonary embolism.
  • Toxicology is part of every sudden-death autopsy: cocaine and other stimulants also cause cardiac death.

Next step: what to do and document

  • Record the history: previous symptoms, fainting, exercise at the time of collapse, family history of sudden death and medicines.
  • If there was resuscitation, record the initial rhythm, shocks and timings, and keep the defibrillator records.
  • Do not write «cardiac arrest» as the cause: it is a mechanism; if there is no known, sufficient natural cause, report the death for a medico-legal autopsy.
  • If the autopsy suggests an inherited disease, or is negative in a young person, refer first-degree relatives to cardiology.
  • In people from endemic areas with cardiomyopathy, ask about Chagas disease and record any serology result.
  • Decree 786 of 1990, art. 6(e): the medico-legal autopsy is mandatory in other deaths whose cause is not clear (see Sudden unexpected death).
  • Official text checked on 2026-11-13 at funcionpublica.gov.co.

Test yourself

Think of the answer, then tap the question to see it.

What is the most common cause of sudden cardiac death in people over 35?

Atherosclerotic coronary artery disease.

How are the coronary arteries examined at a sudden-death autopsy?

With serial transverse cuts every few millimetres along the main arteries and their branches, looking for thrombus, stenosis and anomalies.

What is concluded if the heart is normal and toxicology negative in a young person who died suddenly?

Sudden arrhythmic death syndrome; material is kept for genetics and the family is screened.

Why does Chagas disease matter for sudden death in Colombia?

Because it is endemic and sudden death, usually from ventricular fibrillation, is its leading cause of death, sometimes as the first manifestation.

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Educational content on forensic and legal medicine; not legal advice and no substitute for the technical guides of Colombia's National Institute of Legal Medicine and Forensic Sciences. Laws change: each page links the official text and says when it was last checked. For a real case, follow the guide in force and ask the competent authority.

Sources: Guidelines for autopsy investigation of sudden cardiac death: 2017 update from the Association for European Cardiovascular Pathology (Virchows Archiv (PMC), 2017); Autopsy and sudden death (European Heart Journal Supplements (PMC), 2023); Sudden Cardiac Death Risk Stratification and Prevention in Chagas Disease: A Non-systematic Review of the Literature (Arrhythmia & Electrophysiology Review (PMC), 2020); Decreto 786 de 1990: autopsias clínicas y médico-legales y viscerotomías (compilado en el Decreto 780 de 2016) (Función Pública, Gestor Normativo, 1990).

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