Sudden cardiac death associated with non-atherosclerotic cardiac conditions: a case series

Abstract

Abstract Background Sudden Cardiac Death (SCD) remains a significant and challenging forensic pathology concern, often occurring in seemingly healthy individuals. While the atherosclerotic coronary artery disease is the predominant cause, a substantial proportion of SCD cases, particularly in younger individuals, are attributed to non-atherosclerotic conditions, including structural cardiac pathologies or non-structural causes like channelopathies. Although non-atherosclerotic cardiac diseases constitute a substantial part of SCD cases, they remain an important challenge in the forensic clinical practice with limited description in the literature. Therefore, the aim of this study was to describe the pathological findings of some representative non-atherosclerotic SCD cases encountered during the forensic autopsy and to highlight their diagnostic challenges. Cases presentation We present four distinct cases of non-atherosclerotic sudden cardiac death encountered in our practice: Hypertrophic cardiomyopathy presented with the classic features, including severe myocardial hypertrophy, disarray, and intramural coronary artery; right atrial thrombosis associated with markedly thickened mitral valve and cardiomegaly; mitral valve replacement with prosthetic valve vegetation as a complication of infective endocarditis; and "high take-off" origin of the left coronary artery without significant atherosclerosis. Conclusion This case series underscores the diverse range of non-atherosclerotic cardiac pathologies associated with sudden death. A meticulous and systematic forensic autopsy, encompassing gross and microscopic examination of the heart, is paramount in identifying these often subtle yet lethal conditions, thereby aiding in accurate cause of death determination.