Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust, London, UK.
Br J Sports Med. 2012 Nov;46 Suppl 1(Suppl_1):i15-21. doi: 10.1136/bjsports-2012-091415.
In the UK, when a young person dies suddenly, the coroner is responsible for establishing the cause of death. They will ask a consultant pathologist to carry out an autopsy in order to ascertain when, where and how that person died. Once the cause of death is established and is due to natural causes, the coroner can issue a death certificate. Importantly, the coroner is not particularly interested in the cause of death as long as it is due to natural causes, which avoids the need for an inquest (a public hearing about the death). However, if no identifiable cause is established at the initial autopsy, the coroner can refer the heart to a cardiac pathologist, since the cause of death is usually due to heart disease in most cases. Consultant histopathologists are responsible for the analysis of human tissue from both living individuals and the dead in order to make a diagnosis of disease. With recent advancements in the management protocols for routine autopsy practice and assessment following the sudden death of a young individual, this review describes the role of the consultant histopathologist in the event of a sudden death of a young athletic individual, together with the older middle-aged 'weekend warrior' athlete. It provides concise mechanisms for the main causes of sudden cardiac death (including coronary artery disease, cardiomyopathies, valve abnormalities, major vessel ruptures and electrical conduction abnormalities) based on detailed autopsy data from our specialised cardiac pathology laboratory. Finally, the review will discuss the role of the histopathologist in the event of a 'negative' autopsy.
在英国，当年轻人突然死亡时，验尸官负责确定死因。他们会要求顾问病理学家进行尸检，以确定该人死亡的时间、地点和方式。一旦确定死因是自然原因，验尸官就可以签发死亡证明。重要的是，只要死因是自然原因，验尸官对死因并不特别感兴趣，这避免了需要进行死因裁判官调查（关于死亡的公开听证）。然而，如果在初次尸检时未确定明确的死因，验尸官可以将心脏提交给心脏病理学家，因为在大多数情况下，死因通常是心脏病。顾问组织病理学家负责分析来自活人和死者的人体组织，以做出疾病诊断。随着最近在年轻人突然死亡的常规尸检实践管理协议和评估方面的进展，本综述描述了顾问组织病理学家在年轻运动员突然死亡事件中的作用，以及年龄较大的中年“周末战士”运动员。它根据我们专门的心脏病理学实验室的详细尸检数据，为主要的突发性心源性死亡原因（包括冠状动脉疾病、心肌病、瓣膜异常、大血管破裂和电传导异常）提供了简明的机制。最后，该综述将讨论在“阴性”尸检情况下组织病理学家的作用。
