After an unexpected sudden death, the coroner for the area will usually request that a post-mortem be performed. This involves the body being examined by a pathologist. Small samples of tissue from organs including the heart (to examine for heart failure) are also taken and examined under a microscope. Usually, the pathologist can easily detect any abnormality like significant coronary artery disease. The coroner will take into account the circumstances of the death and, if necessary, will carry out tests for signs of any medication or drugs.
If it is difficult to assess the heart or to detect any abnormality in it, it is desirable for the help of an expert cardiac pathologist (one who specialises in the heart) to determine the cause of death.
This, at present, is likely to necessitate referral through the coroner or pathologist to an expert cardiac pathologist in the United Kingdom.
If the cause of death is known to be a hereditary problem (such as some forms of cardiomyopathies, or heart muscle diseases, many causes of SADS, Marfan’s disease), then immediate family should be screened as a precaution. This usually means the parents, brothers and sisters, and if appropriate the children of the deceased should be checked for evidence of the same condition. Testing can then be extended or ‘cascaded’ to the wider family if someone else in the immediate family is considered to be affected. Or, where the cause of death is uncertain (this includes SADS, and may occasionally be relevant to cot deaths), the relatives should be screened for any clues as to possible causes of death, such as the electrical conditions lonq QT syndrome or Brugada syndrome. Further information on the tests that are usually performed is available on our screening page.