Prehospital sudden death from ischaemic heart disease a postmortem study

Abstract

A detailed postmortem study of the myocardium and coronary arteries was performed on 114 men and 37 women who died suddenly outside hospital. Data on the disease history and certain risk factors were collected through an 'Ischaemic Heart Disease Register'. Men and women did not differ with respect to history of previous symptoms of ischaemic heart disease or necropsy findings. A history of hypertension and the previous use of digitalis or diuretics tended to be more frequent in women than in men but current smoking was more common in men (69%) than in women (43%). Of the subjects in whom necropsy revealed an old myocardial infarction, 86 per cent had a history of symptomatic ischaemic heart disease but a previous myocardial infarction was known in only 42 per cent of them. A definite recent myocardial infarction was found in 26 per cent and an early infarction in 51 per cent. About half of the patients with a definite recent or an early myocardial infarction, and half of those with no recent myocardial infarct, died at once. Fourteen per cent of the subjects died after symptoms lasting 2 hours or more. Triple vessel disease in the coronary arteries was found in 56 per cent of cases, double vessel disease in 31 per cent, and single vessel disease in 11 per cent. Aorticvalvular stenosis or a history of hypertension was present in 3 cases with no obvious coronary disease. Suddenness of death did not correlate with severity of coronary obstruction. Arterial lesions were more severe in patients with an old myocardial infarction than in those without this. The more severe the coronary artery disease, the more likely a definite recent myocardial infarction was to be present. The mildest disease was found in patients with no detectable recent myocardial infarction. No significant differences were found between patients with symptomatic and those with silent but definite myocardial infarction. Heavy smoking was most common in patients with an early recent myocardial infarction. Patients dying without warning and with no recent infarction (those with a primary arrhythmia) had severe coronary artery disease less frequently than those dying with a recent infarction. None of the former had been heavy smokers. They had, however, large scarred hearts, and a high incidence of previous hypertension, of ischaemic heart disease, and of treatment with digitalis or diuretics.