Advances in pharmacotoxicological investigation of Sudden Cardiac Death: literature review and novel perspectives

Pharmacotoxicology is one of the fields that in recent years is growing exponentially, further reaffirming its proven usefulness in the field of forensic sciences. An interesting goal in this field is to identify and quantify the cause of death. This review paper aims to represent a review of the literature in order to evaluate the state of the art regarding the research in the pharmacotoxicology field in cases of Sudden Cardiac Death (SCD), a frequent problem on several occasions, which can be derived from the use of fatal substances or in such concentrations causing sudden death. In this overview, the most frequently observed biomarkers for SCD were found to be ethanol, illicit drugs, antidepressants, and some common compounds like caffeine and Trenbolone. Concurrently, the most applied instrument configurations is represented by hyphenated liquid (or gas) chromatographic tools coupled with mass spectrometry (LC-MS or GC-MS) in order to reach the high accuracy and confidence levels in the confirmatory analyses, preceded by common sample preparation technique as solid-liquid extraction or liquid-liquid extraction. It was interesting to understand the approaches by which researchers have approached the topic, because on the one hand there are those who have been interested in the comparison between matrices (conventional and not) and on the other hand, who has researched metabolites in order to be able to trace the intake or not of a substance. In particular, this work want to highlight and evaluate, from a medical-legal point of view, which are the main biomarkers and physiological markers of forensic interest and the methods, and instrumental procedures most frequently used for their evaluation. The paper is organized considering the analytical methods divided by types of drugs/substances.