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Abstract -62- 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) -------- ----- - ---- ---- |