Sudden Natural Death ‘At the Wheel’—Revisited

A study of sudden natural death occurring in a motor vehicle was performed on the case files of the Office of the Medical Examiner of Metropolitan Dade County in Miami, Florida, during the years 1980–84. A total of 133 autopsied cases were collected and analysed as to the age, race, sex, cause of death, blood alcohol content, height, weight, heart weight, heart histology, severity of coronary artery disease, past medical history, medication, role of the occupant, time of occurrence, and scene circumstances. Essentially, the ‘natural death at the wheel’ of the 1980s involves an older (greater than age 55 years) white male who dies from atherosclerotic heart disease (occlusive coronary artery disease). He is most commonly sober at the time of the incident, which most frequently is the afternoon or evening. The deceased usually was the driver who either ‘veered off’ and crashed the vehicle into an object or was found ‘collapsed’ in the vehicle. ‘Veering off’ the road without a crash occurred less frequently. Most victims had a pre-existent medical condition but were without medication. At autopsy the heart weights (average 533.5 gm) were enlarged and severe coronary artery disease was present. A discussion ensues comparing these findings with other studies.