Two case reports of sudden cardiac arrest with unsuccessful resuscitation: is there a role for postmortem investigation and targeted next generation sequencing?

Abstract

Background: Sudden unexpected cardiac arrest is one of the life-threatening interventions of the pre hospital emergency medicine teams. Globally sudden cardiac death (SCD) accounts for 4-5 million deaths per year and is in most cases linked to coronary artery disease. Other causes include cardiomyopathies and channelopathies, but these are not always clear to the physician. Case Presentation: We present two unconscious patients with life-threatening cardiac arrests who were unsuccessfully resuscitated by the emergency team. As the cause of the sudden cardiac arrest was unclear an autopsy was performed. Conclusion: SCD can be the final stage of several pathologies. In acute myocardial infarction due to coronary artery disease, the underlying cause is clear. The situation is however more complex in drug abuse where the physician should be aware that underlying pathologies can be masked. If the cause of sudden cardiac arrest is unclear, a "molecular" autopsy is recommended to detect genetic susceptibility to dysrhythmias( long QT syndrome, Brugada syndrome), cardiomyopathies, thoracic aortic aneurysm, and dissection. Correlating significant clinical information, postmortem findings and genetic analysis can be used to detect underlying pathologies and to decide whether genetic screening and clinical follow up of relatives should be carried out.