Sudden unexpected death in adults and infants
- Topic
Sudden death is the quick death of an apparently healthy person without an obvious cause; it needs investigation and nearly always an autopsy.
What it is
Sudden cardiac death is a natural, unexpected fatal event within one hour of symptom onset in an apparently healthy person; if unwitnessed, it is taken as sudden if the person was well in the previous 24 hours. Over age 35 the commonest cause is coronary artery disease; in the young, cardiomyopathies, myocarditis, coronary anomalies and channelopathies predominate. When autopsy and toxicology are negative and the heart is normal, the term is sudden arrhythmic death syndrome, which may be inherited. In infants, sudden unexpected infant death (under one year) includes sudden infant death syndrome, accidental suffocation during sleep and deaths of unknown cause; sudden infant death syndrome is a diagnosis of exclusion that requires autopsy, a scene investigation and the clinical history.
Key facts
- About two thirds of sudden cardiac deaths are the first manifestation of the disease.
- The autopsy should include examination of the whole heart, histology and toxicology.
- Samples for genetics: EDTA blood and a piece of spleen or heart, frozen.
- Infants: investigation of the sleep setting (surface, position, bedding, bed-sharing) is part of the diagnosis.
- Before accepting a natural cause in an infant, exclude abuse, suffocation and poisoning.
Next step: what to do and document
- Record the witnesses' account: what the person was doing, prior symptoms, time of collapse, resuscitation steps and timings.
- If there is no known and sufficient natural cause, do not certify: notify the judicial police so a medico-legal autopsy is ordered.
- In an infant, document without judgement the position, surface and sleep setting, and look for and record injuries systematically.
- If the autopsy does not explain the death of a young person, refer first-degree relatives to cardiology for screening.
- Support the family and explain respectfully why the autopsy is needed.
Legal framework in Colombia
- Decree 786 of 1990, art. 6, item e: medico-legal autopsy is mandatory in other deaths of unclear cause (compiled in Decree 780 of 2016, art. 2.8.9.6).
- Decree 786 of 1990, art. 7, item d: autopsies on minors when death from neglect or abuse is suspected are singled out.
- Official text checked on 2026-11-05 at funcionpublica.gov.co.
Test yourself
Think of the answer, then tap the question to see it.
How is sudden cardiac death defined?
A natural, unexpected fatal event within the first hour of symptom onset in an apparently healthy person.
What is the commonest cause of sudden cardiac death over age 35?
Atherosclerotic coronary artery disease.
Why is sudden infant death syndrome a diagnosis of exclusion?
Because it is accepted only after a complete autopsy, a scene investigation and review of the clinical history find no other cause.
What is done if the autopsy of a young person with sudden death is negative?
Material is kept for genetic testing and first-degree relatives are referred for cardiac screening, because of a possible inherited channelopathy.
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Connections
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 (Basso C et al.) (Virchows Archiv, 2017); About SUID and SIDS (Centers for Disease Control and Prevention (CDC), 2024); Decree 786 of 1990: clinical and medico-legal autopsies and viscerotomies (compiled in Decree 780 of 2016) (Función Pública, Gestor Normativo, 1990).
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