PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of brheartjLink to Publisher's site
 
Br Heart J. 1992 December; 68(6): 601–607.
PMCID: PMC1025692

Non-atherosclerotic coronary artery disease and sudden death in the young

Abstract

Objective—To assess prevalence and type of non-atherosclerotic coronary artery disease in young people (≤35 years) who died suddenly.

Design—A necropsy study of 150 consecutive cases of sudden death (that is, within 6 h of the onset of symptoms).

Results—Death was attributed to coronary artery disease in 48 cases: in 16 (33%) of them the disease was non-atherosclerotic. Twelve subjects (eight males and four females, age range 2–35 years, mean 24·2) had congenital anomalies: a deep intramyocardial course in six, origin from the wrong sinus in three, and ostial obstructions in three. Sudden death was the first manifestation of disease in six cases. The other six had a history of palpitation or syncope or both. An electrocardiogram was available in five cases and showed ventricular arrhythmias in four; none had angina pectoris. Stress testing was available in two cases: neither showed any effort-dependent ST-T abnormalities. In six cases sudden death was related to physical exercise. Acquired non-atherosclerotic coronary artery disease was found in four cases: spontaneous coronary dissection in three previously symptom free patients and Kawasaki coronary arteritis in one child who had had acute myocardial infarction.

Conclusion—One third of the cases of fatal coronary artery disease were non-atherosclerotic with coronary artery anomalies being the most frequent form. Coronary artery anomalies should be suspected in young patients who have symptoms of ventricular arrhythmias without any overt signs and symptoms of ischaemia.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (4.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.
 
 

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Kuller L, Cooper M, Perper J. Epidemiology of sudden death. Arch Intern Med. 1972 May;129(5):714–719. [PubMed]
  • Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984 May 3;310(18):1137–1140. [PubMed]
  • Waters DD, Bosch X, Bouchard A, Moise A, Roy D, Pelletier G, Théroux P. Comparison of clinical variables and variables derived from a limited predischarge exercise test as predictors of early and late mortality after myocardial infarction. J Am Coll Cardiol. 1985 Jan;5(1):1–8. [PubMed]
  • Waller BF. Exercise-related sudden death in young (age less than or equal to 30 years) and old (age greater than 30 years) conditioned subjects. Cardiovasc Clin. 1985;15(2):9–73. [PubMed]
  • Thiene G, Nava A, Corrado D, Rossi L, Pennelli N. Right ventricular cardiomyopathy and sudden death in young people. N Engl J Med. 1988 Jan 21;318(3):129–133. [PubMed]
  • Corrado D, Thiene G, Nava A, Rossi L, Pennelli N. Sudden death in young competitive athletes: clinicopathologic correlations in 22 cases. Am J Med. 1990 Nov;89(5):588–596. [PubMed]
  • Burke AP, Farb A, Virmani R, Goodin J, Smialek JE. Sports-related and non-sports-related sudden cardiac death in young adults. Am Heart J. 1991 Feb;121(2 Pt 1):568–575. [PubMed]
  • Thiene G, Pennelli N, Rossi L. Cardiac conduction system abnormalities as a possible cause of sudden death in young athletes. Hum Pathol. 1983 Aug;14(8):704–709. [PubMed]
  • Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR, Blackbourne BD, Davis JH. Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death. Circulation. 1974 May;49(5):790–798. [PubMed]
  • Friedman M, Manwaring JH, Rosenman RH, Donlon G, Ortega P, Grube SM. Instantaneous and sudden deaths. Clinical and pathological differentiation in coronary artery disease. JAMA. 1973 Sep 10;225(11):1319–1328. [PubMed]
  • GEIRINGER E. The mural coronary. Am Heart J. 1951 Mar;41(3):359–368. [PubMed]
  • Angelini P, Trivellato M, Donis J, Leachman RD. Myocardial bridges: a review. Prog Cardiovasc Dis. 1983 Jul-Aug;26(1):75–88. [PubMed]
  • Noble J, Bourassa MG, Petitclerc R, Dyrda I. Myocardial bridging and milking effect of the left anterior descending coronary artery: normal variant or obstruction? Am J Cardiol. 1976 Jun;37(7):993–999. [PubMed]
  • Ishimori T, Raizner AE, Chahine RA, Awdeh M, Luchi RJ. Myocardial bridges in man: clinical correlations and angiographic accentuation with nitroglycerin. Cathet Cardiovasc Diagn. 1977;3(1):59–65. [PubMed]
  • Faruqui AM, Maloy WC, Felner JM, Schlant RC, Logan WD, Symbas P. Symptomatic myocardial bridging of coronary artery. Am J Cardiol. 1978 Jun;41(7):1305–1310. [PubMed]
  • Feldman AM, Baughman KL. Myocardial infarction associated with a myocardial bridge. Am Heart J. 1986 Apr;111(4):784–787. [PubMed]
  • Vasan RS, Bahl VK, Rajani M. Myocardial infarction associated with a myocardial bridge. Int J Cardiol. 1989 Nov;25(2):240–241. [PubMed]
  • Morales AR, Romanelli R, Boucek RJ. The mural left anterior descending coronary artery, strenuous exercise and sudden death. Circulation. 1980 Aug;62(2):230–237. [PubMed]
  • Froment R, Normand J, Amiel L. Angine de poitrine du type Prinzmetal. Coronaires perméables, mais spasme de l'inter-ventriculaire antérieure en cours de crise. Arch Mal Coeur Vaiss. 1973 Jun;66(6):755–761. [PubMed]
  • Kuhn FE, Reagan K, Mohler ER, 3rd, Satler LF, Lu DY, Rackley CE. Evidence for endothelial dysfunction and enhanced vasoconstriction in myocardial bridges. Am Heart J. 1991 Dec;122(6):1764–1766. [PubMed]
  • Ferreira AG, Jr, Trotter SE, König B, Jr, Décourt LV, Fox K, Olsen EG. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991 Nov;66(5):364–367. [PMC free article] [PubMed]
  • Cheitlin MD, De Castro CM, McAllister HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva, A not-so-minor congenital anomaly. Circulation. 1974 Oct;50(4):780–787. [PubMed]
  • Roberts WC, Siegel RJ, Zipes DP. Origin of the right coronary artery from the left sinus of valsalva and its functional consequences: analysis of 10 necropsy patients. Am J Cardiol. 1982 Mar;49(4):863–868. [PubMed]
  • Liberthson RR, Dinsmore RE, Fallon JT. Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management. Circulation. 1979 Apr;59(4):748–754. [PubMed]
  • Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-1989. Sudden collapse of a 17-year-old girl during exertion. N Engl J Med. 1989 Jun 1;320(22):1475–1483. [PubMed]
  • Weyman AE, Feigenbaum H, Dillon JC, Johnston KW, Eggleton RC. Noninvasive visualization of the left main coronary artery by cross-sectional echocardiography. Circulation. 1976 Aug;54(2):169–174. [PubMed]
  • Maron BJ, Leon MB, Swain JA, Cannon RO, 3rd, Pelliccia A. Prospective identification by two-dimensional echocardiography of anomalous origin of the left main coronary artery from the right sinus of Valsalva. Am J Cardiol. 1991 Jul 1;68(1):140–142. [PubMed]
  • Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986 May;111(5):941–963. [PubMed]
  • Virmani R, Chun PK, Goldstein RE, Robinowitz M, McAllister HA. Acute takeoffs of the coronary arteries along the aortic wall and congenital coronary ostial valve-like ridges: association with sudden death. J Am Coll Cardiol. 1984 Mar;3(3):766–771. [PubMed]
  • Ciraulo DA, Chesne RB. Coronary arterial dissection: an unrecognized cause of myocardial infarction, with subsequent coronary arterial patency. Chest. 1978 May;73(5):677–679. [PubMed]
  • Baker PB, Keyhani-Rofagha S, Graham RL, Sharma HM. Dissecting hematoma (aneurysm) of coronary arteries. Am J Med. 1986 Feb;80(2):317–319. [PubMed]
  • Shaver PJ, Carrig TF, Baker WP. Postpartum coronary artery dissection. Br Heart J. 1978 Jan;40(1):83–86. [PMC free article] [PubMed]
  • DeMaio SJ, Jr, Kinsella SH, Silverman ME. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 1989 Sep 1;64(8):471–474. [PubMed]
  • Cocco P, Thiene G, Corrado D, Lodovichetti G, Pennelli N. Ematoma (aneurisma) dissecante spontaneo delle coronarie e morte improvvisa. G Ital Cardiol. 1990 Sep;20(9):795–800. [PubMed]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group