Recent events have caused the need to dig deeper into finding phenotype markers for sudden cardiac death. Several cases have been reviewed and found to bear a definite geno-phenotype, inherent, defect in each and every case. Simultaneously, articles dealing with cardiac assessment of pathology at autopsy have shown a huge void regarding the potential for making an accurate evaluation of the heart post mortem or at autopsy. One case that is of partucular note is the one involving the Florida A&M student who was hazed and found at autopsy to have been the victim of a homicide. Yet cardiac pathology was later found to be a confounding factor in this student’s premature and untimely demise.
It is not possible to do an EKG on a dead person to check for problems. In cases of suspected cardiac pathology it is recommended by most experts to consult a specialist in cardiac pathology when the general pathologist is not able to make a definitive cause of death. My experience personally and professionally has taught me that cardiac condtions causing sudden death are not rare at all. My neighbor, whom I had grown close to, was found in bed by his mother and was later found to have had a heart attack. HE WAS ONLY SEVENTEEN YEARS OLD. I suspect that many cases of sudden unexplained death are due to cardiac pathology that was not symptomatic or noticed until the time of death. Wolf Parkinson White and other arrythmias can lay dorment as far as symptoms are concerned or be so mild as to be ignored by the person until unfortunately stress or other event causes it to surface in a powerful and dramatic way. It is possible for there to be no known precipitating factors except some sort of circadian rhythm that triggers the event. Arrythmias, like long QT syndrome, have recently been given notice in the causation of Sudden Infant Death Syndrome or SIDS. If sudden cardiac death can occur in infancy it can surely occur in childhood or adolescence.
Currently, one does not even have to be a pathologist, nor even a physician to be a coroner. Some write that the coroner’s office is even unregulated with no standards or skills certification requirements. Many author’s agree that this is an undue burden on persons who act as coroners and who do not have the cardiac pathology skills to adequately assess sudden death scenarios nor have the available funding to consult with specialists when needed. In fact, some even admit that arrythmias as cause of death are not possible to be detected at autopsy by any of the current means. The Phenome Project shows promise in filling this void.
Now the case of the teenager who died in a Georgia university dormitory comes to surface. The ex-boyfriend has turned himself in since authorities suspected homicide even though the autopsy was inconclusive, reportedly. Asphyxiation has been conjectured to be the cause of death. Asphyxiation should be possible to detect at autopsy as a cause of death. So why is the autopsy called inconclusive? Perhaps they wait for further results and tests. Anyway, if no homicide is found to be the cause, then this is another case of juvenile cardiac pathology causing sudden death. For those willing and interested in the truth, a consult with our service is in order.
1. Things to Know- How Qualified is your coroner? www.pbs.org/wgbh
2. The Negative Autopsy. on web at Science Direct. from Cardiovascular Pathology by Stephen Cohle and Barbara Sampson