The Causes and Prevention of Sudden Death in Coronary Disease

Aside from the mounting mortality toll that would appear inevitable with the generally increased incidence of coronary disease, the problem of minimizing the occurrence of fatal complications of myocardial infarction resulting from coronary occlusion, as far as they are subject to control, presents a clinical challenge that can be met only by a careful analysis of the actual immediate causes of death following the occurrence and during the recovery stage of myocardial infarction. Acute myocardial infarction may occur in the course of coronary atherosclerosis as a consequence of any one of the following circumstances: Thrombosis of a narrowed atherosclerotic coronary vessel. Intramural hemorrhage in a coronary vessel producing closure. Rupture of a subintimal lipoid abscess with plugging of the lumen. Infarction occurring without complete organic occlusion of a coronary vessel. The last mentioned circumstance might be induced by prolonged coronary insufficiency, such as a protracted anginal