Guidelines for forensic assessment of natural unexpected cardiovascular death

Sudden unexpected deaths due to cardiovascular diseases make up almost half of all natural deaths. Practical guidelines are needed for forensic autopsy practice in cases of natural unexpected deaths due to ischemic heart disease or other cardiovascular diseases in Korea. An evaluation of the clinical history is the first step, including the collection of all available information on the subject. As a standard autopsy procedure, every subsystem of the heart and vessels should be thoroughly studied including the coronary arteries, the myocardium, the cardiac valves, and the conducting system. In addition, histological, toxicological, biochemical and molecular analysis need to be applied to the detection of myocardial infarction from the medico‐legal point of view. Also important is the assessment of risk factors for natural unexpected cardiac death (NUCD) in order to establish a cause–effect relationship. There are three groups of ischemic conditions of heart leading to NUCD, those being acute myocardial infarction, atherosclerotic heart disease and critical coronary atherosclerosis. Additionally, there are practical concerns on formulating the report. Pathologists may use sudden cardiac death or NUCD as a main diagnosis when there is no alternative diagnosis, though they would do better to comment on conditions contributing to the death. Finally, pathologists should be encouraged to suspect unexplained causes of death in order to find clearer answers.