Despite significant enhancements in resuscitation methodology, survival after sudden cardiac arrest remains low. Improved knowledge of warning signs and symptoms may help to detect victims for sudden death.

to study the warning symptoms prior to sudden cardiac death.

We prospectively collected epidemiological and autopsy data from victims of sudden cardiac death in northern Tunisia (3.6 million people) between October 2012 and September 2013. We included victims ?20 years old requiring a forensic autopsy.

Data (risk factors, symptoms) were collected by assessment of the accounts of family members/relatives, witnesses, as well as medical records during this time period.

The heart was weighed and then investigated by macroscopic examination looking for scars of myocardial infarction. The three main coronary arteries were macroscopically examined by transverse slices at 2-3-mm intervals along their lengths.

Of the 542 sudden deaths within the study period, 372 males and 91 females were medico-legally autopsied. Mean age of victims was 50.9±15 years. Physical inactivity and smoking were the most common risk factors, accounting for 74.7% and 61.5%, respectively. A family history of sudden death was identified in 10.8% of victims. Most deaths occurred in a public place (39.3%) or at home (36.9%).

Of the total deaths, 298 (64.4%) occurred while the individuals were relaxing, 52 (11.2%) while sleeping, 92 (19.9%) while dealing with an activity, and 21 (4.5%) under emotional stress.

Syncope was the most frequent symptom occurring in 36.1%, chest pain in 18.6%, dyspnea in 8.6% and 10.1% had dizziness or fainting.

The autopsic study showed that 231 deaths (49.9%) were due to coronary artery diseases. Eight percent of victims have consulted a doctor within the last 48 hours and 21% up to 1 month.

Warning symptoms prior to sudden cardiac death may occur longer before the death. Recognizing these precocious signs could have implications for prevention of this public health problem.