Pathology of the Heart and Sudden Death in Forensic Medicine PDF

Preface

In most jurisdictions of Western societies, sudden and unexpected deaths are mainly due to natural causes linked with heart diseases by an initiating factor triggering cardiac arrest. Advances in technology will procure a histo-ultrastructural view in living people. At present, however, the autopsy remains the gold standard; with the proviso that the diminishing requests for postmortem examination by clinicians may, in the future, confine autopsy investigation to forensic institutions. Science will continue to be nourished by well-suited hypotheses, but science advances on incontrovertible facts that, at present, only an autopsy can give.

In general, forensic pathology is mainly concerned with determining the role of trauma, intoxication, or poisoning in the cause of sudden and unexpected death as defined within legal boundaries. Its purpose is to settle whether death was due to natural causes or was a result of accident, suicide, or murder, and so help establish legal responsibility. So when performing an autopsy, the medical examiner and the pathologist should carefully investigate the inductive cause of sudden death, the history of disease, and the family history, in order to rule out the possibility of the above disorders.

With the marked advances in molecular techniques, DNA testing on peripheral blood and tissue has revolutionized the diagnosis of genetic causes of sudden death.

Although toxicological analyses are indispensable for final clarification of the cause of death, postmortem (external and internal) examination remains a fundamental challenge in forensic investigation. Because heart disease is responsible for most abusers' deaths, the study of macro and micro cardiac alterations is an essential step for the forensic pathologist.

That prompted us to write this book presenting the pathology of the heart/cardiovascular system with a forensic perspective. This is a book in which one can deliberate over recorded findings and then gain an understanding of how to make a critical, overall interpretation. This interpretation then guides the forensic pathologist in a court of law as the forensic pathologist takes on the role of interpreter of the sequence of events that led to death.

The recommendations presented in this book, along with others, are useful to the pathologist who will learn how to better collect and file the preliminary and necessary evidence needed for forensic judgment. In fact, it presumes an absolutely clear objectivity (supported by photographic, microfilm documents) and a willingness to investigate.

The harmonization of forensic autopsy rules is an essential initiative, not only for epidemiological and statistical aims, but also for unification in listing data and making that data available so that knowledge of the cause of death and the possible identification of that cause will be known. (There is also a project underway to develop a unique scheme for the autopsy protocol.) In addition to the general rules, this recommendation underlines particular ways of checking and drawing conclusions concerning the cardiovascular apparatus and, specifically, sudden death.