The immediate antecedents of sudden death.

Abstract

ABSTRACTA 5 yr prospective survey of 1839 coronary heart disease (CHD) deaths, in 260.000 employed men aged 20–65 – and a detailed study of 142 deaths of all causes in 1020 men aged 40–65 who were observed for 5 yrs with repeated examinations and 24 hr ECG recordings shows the following:60.4% of CHD deaths were «sudden» (SD) in <1 hr; 42.5% of SDs were in men not previously known to have heart disease. The cardiac phenomena of all deaths could be classified as «arrhythmic» (ARD) or «circulatory failture» (CFD). 91% of SDs in <1 hr and 85% of SDs in <24 hrs were ARDs. ARDs and CFDs occurred under different conditions with different precipitating causes and different predictive «risk factors».At time of death 85% of ARDs were asleep, 88% awake and 42% active. 92.5% had myocardial disease: occlusions of major coronary vessels, scarring or fibrosis; recent acute MI or CO; hypertrophy 400 gms 80%; congestive heart failure 45%; cardiac dilatation 23%. 25% had severe anemia or anoxemia. 85% had major chronic disorders of rhythm or conduction (VPCs 10/1000 36%; pairs of PVC 15%; EC VPCs 23%; QRS . 11 sec 28 %).At time of death 100% of CFDs were comatose and not arousable. 48% had no clinical evidence of heart disease. 57% had myocardial disease: definite CHD 26%; hypertrophy 400 gms 47%; chronic CHF 29%; cardiac dilatation 13%. 27% had major disorders of rhythm or conduction (VPC 10/1000 20%; pairs of PVC 10%; EC VPCs none; QRS. 11 sec 10%).ARDs were precipitated by activities known to be associated with vagal effects on heart in 17.1% of the men; by activities known to be associated with sympathetic effects of heart in 34.1%, episodes of acute myocardial ischemia in 14.6%; or occurred during no apparent precipitating event in 34.1%. CFDs were precipitated by hemorrhage, trauma, infection, stroke, or other cause of peripheral vascular failure (87%), and by myocardial failure (13%).Risk factors at age 55 for ARD in 5 years are confounded and interact. Men with combinations have higher risk. A risk factor for CFD is the presence of potentially fatal non‐cardiac disease likely to cause coma or peripheral vascular collapse.