Abstract
Complete and accurate examination of the heart is the key to determining the cause and the manner of death in a medico-legal autopsy more often than is examination of any other organ. Therefore, it is appropriate that the second issue of Academic Forensic Pathology focuses on the heart. In the forensic setting the sudden, unexpected death of an infant or young person is a common and vexing problem. The complete investigation of such a death begins with the history. Medical history, family history and circumstances of death are all critically important. A particularly difficult challenge is the determination of the cause of death in the setting of a negative autopsy. This topic is reviewed in detail.
In patients with established cardiovascular disease, evaluation of the medical or surgical interventions which occurred is important. This can uncover unforeseen complications. It is the duty of the medical examiner to report such complications to treating physicians, government agencies or manufacturers, as appropriate.
Documentation of natural cardiac disease is also important in a violent death. In certain situations cardiovascular disease may be contributory to the cause of death when the manner is violent. In this situation, clear understanding of the mechanism of death can have important legal ramifications. The extreme example of this is stress cardiomyopathy when emotional stress results in a lethal cardiac arrhythmia. In any situation, documentation of natural cardiovascular disease, even a disease as common as atherosclerotic cardiovascular disease, may have consequences for surviving family members. This documentation must be done accurately because any disease specified in an autopsy report or death certificate may have long term legal, financial and genetic consequences.
The accuracy of the death certificate is a major responsibility of the medical examiner or coroner. Some of these professionals feel that once they are comfortable that a death is natural, their responsibility ends. I could not disagree more. In that situation, we have failed in our responsibility to the decedent's family members at the worst time in their lives. We owe them our best attempt to explain the loss of their loved one. In addition, what we write on death certificates has bearing on public health and vital statistics. This can influence public policy and the financial support of various programs. It can also have tremendous consequences for families attempting to claim insurance benefits. We should not take this responsibility lightly.
This issue describes the forensic approach to sudden death, dissection of the heart, and the pathology of a few common cardiovascular disorders and their interventions commonly encountered in the medico-legal autopsy. Emphasis is placed on those anomalies which have a genetic basis. This is the future of cardiovascular pathology, and, therefore, appropriate and important information for the practicing forensic pathologist. In some situations involving less common disorders, the consultation of a cardiovascular pathology specialist or geneticist may be warranted. The Society of Cardiovascular Pathology (http://scvp.net/) is an organization dedicated to the advancement of understanding of cardiovascular disorders. Many of the articles herein are written by its members.
