الفهرس 
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Abstract
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In order to teet whether sudden coronary death patients
had a more ”vulnerable” myocardium compared with other patients,
morphological lesions of the myocardium and conduction
system were examined in a selected autopsy series.
Chornic inflammatory microlesions, frequently affecting
single muscle fibers, predominated among 47 sudden coronary
death cases compared with 34 cases with chronic coronary or
noncoronary diseases. Nonfibrous lesions ~f the atrioventircular
nodes and the bundle of His also predominated among
the sudden death cases. Myocardial infarcts of any age as well
as relative heart weight (the ratio: total heart weight/body
weight) did not differ in the sudden coronary death and the
chronic coronary patients.
Recent myocardial infarcts were found in small and similar
proportions of both the sudden death and chronic coronary
cases. Since the recent infarcts were few, and no difference
existed between the two disease groups, one might conclude
that acute myocardial infarction did not seem to play a major
role in the pathogenesis of sudden coronary death in this
series. No definite conclusion can be made on this point,
however, since the technique applied in the study is inadequate
for the detection of very early infarcts.
-63-
Thus the present study demonstrates, in the majority of
,
sudden coronary death patients, the following:
(1) conventional ischemic myooardial lesions (recent and old
myocsrdial infarcts, fibrous lesions of the conduction
system) in similar quantities as compared with the control
group of chronic coronary patients, and,
(2) Chronic inflammatory microlesions prepondering among the
sudden coronary death cases, indicating a chronic, continuous,
and / or possibly relapsing process in the myocardium
of these cases. ( Burch, E., et al., 1975).
There is an important difference between ischamia, reversible
event, and necrosis or infarction which is irreversible,
Experimentally, a decreased blood supply or increased hemodynamically
induced oxygen demand, or increased catecholamine
activity can worsen the severity of the ischemic process and
the extent of the ultimate infarction.
A consideration of the time scale involved suggests
that therapeutic intervention could be justified for at least
some hours post-coronary ligation or after the onset of symptoms
in patients. However, in most severely ischemic zones,
irreversibility would already have set in by 20 to 40 minutes
after complete coronary occlusion. (George, E., et al., 1980)
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