The pathologic basis of sudden death

Abstract

The innumerable conditions associated with or causing sudden unexpected death are reviewed, with particular attention to the pathologic basis of sudden cardiac death. Diseases of the cardiovascular system account for the majority of sudden deaths, and coronary artery disease is considered to be responsible for most cases of sudden cardiac death. It was emphasized that a proportion of sudden cardiac deaths exhibit no significant myocradial or coronary artery pathology which might reasonably account for death, and the validity of including such cases in the category of sudden death due to ischemic heart disease has been questioned. It is suggested that the category, sudden unexpected death due to ischemic heart disease be more carefully and critically defined for future epidemiological studies, and that alternate pathophysiological mechanisms which might account for sudden cardiac death be rigorously sought and studied. The potential importance of pathologic lesions in the conduction system has been discussed, and it is recommended that an examination of the conduction system and its blood supply become a routine in all cases of sudden death. Additionally, the role of microvascular disease, including coronary micro-embolism has been stressed as a potential mechanism for sudden cardiac death, and the need for research studies in this area has been emphasized.