Sadly, many people present by dying suddenly; the first doctor to assess them is the coroner’s pathologist. The autopsy is really important in this tragic situation, because it may provide information that will allow prevention of SCD in other family members. Some inherited conditions that predispose to SCD, such as hypertrophic cardiomyopathy (HCM) and arrhythmogenic right ventricular cardiomyopathy (ARVC), may not be easy to confirm or exclude at a routine autopsy and detailed examination of hearts of SCD victims by an expert cardiac pathologist is recommended. When an autopsy identifies an inherited abnormality, there is an opportunity to screen family members to identify others at risk, in whom treatment may prevent SCD. When autopsy finds no abnormality to explain death, this is regarded as sudden adult death syndrome (SADS). This should always trigger consideration of whether or not there may have been a purely ‘electrical’ inherited cardiac condition that may be present in other family members.

Some people present with ‘failed sudden death’, when a person suffers cardiac arrest from which cardiopulmonary resuscitation (CPR) is successful. Increased public access to effective CPR and early defibrillation has increased the incidence of this situation. This provides an important opportunity to assess and offer preventative treatment to the survivor of the arrest and, when there is an inherited cause, to family members at risk. Healthcare professionals involved in successful resuscitation from cardiac arrest and in post-resuscitation care have a unique opportunity to identify individuals with a high risk of further cardiac arrest and those who have an inherited basis for cardiac arrest, with implications for family members.