Role of the Expert Pathologist

Since many of the causes of sudden death lie in the heart it is essential that this is examined by a pathologist with expertise in looking at the heart and diagnosing specific heart diseases.

The expert cardiac pathologist is usually approached by the referring pathologist who has done the initial autopsy with the consent of the coroner.

The referring pathologist will discuss the case with the cardiac pathologist and will then decide whether to send on the whole heart or small samples for the opinion of the cardiac pathologist. The family will be informed of this.
With the CRY funding donated to the Royal Brompton Hospital and Imperial College, we have established a national referral centre so pathologists can have the option of referring cases to the CRY Centre for Cardiac Pathology (CRY CCP) at no cost to the NHS. I have had 15 years experience in this field and have been recognised as an internati
death.Unfortunately, throughout the United Kingdom there are very few expert cardiac pathologists. Previously, UK based pathologists had nobody to send their hearts to when there was a complex heart case since there is no national referral centre established onal expert on sudden cardiacwithin the NHS for such investigations.

At post mortem it is not always possible to identify what the young person has died of by looking at the heart with the naked eye. The expert caridac pathologist needs histological analysis of small pieces of heart to diagnose many heart conditions. It is always essential to take small pieces of tissues for microscopic analysis at each autopsy. In addition,
The process of the pathological investigation usually takes two weeks from referral. With the introduction of the CRY CCP, UK pathologists now have a specialist centre they can send hearts to without worrying about the cost, as the coroner had to fund these cases in the past.electrical abnormalities which cause the heart to stop leave no mark in the heart and it is important for the pathologist to make sure the heart is absolutely normal before suggesting that the patient has died of an electrical abnormality.

The difference the CRY CCP service has made is that we have designated administrative staff to deal with the complex bureaucracy involved in identification and the use of human material. In addition we have designated scientific staff who can quickly process the heart

for microscopic analysis after we have looked at and examined it in detail. The dedicated staff mean we can issue a cause of death within two weeks of receiving the heart from the referring pathologist. In the past these reports were not available to the family for many months, or sometimes years.

Knowing the exact cause of the sudden death comes as a source of comfort and closure for families and helps them to come to terms with the death. It is also essential for
This will guide the exact type of screening programme the family needs cardiological screening of the families if an inherited cause is found.

Professor Mary Sheppard MBBCh FRCPath