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Non‐atherosclerotic heart disease should be looked for when coronary disease is suspected or when death is sudden and apparently unexplained, say doctors in Italy who uncovered four such cases in routine necropsies. This is particularly important for forensic pathologists and to avoid underestimating coronary causes of sudden death.
Death was attributed to arrhythmia secondary to myocardial ischaemia from non‐atherosclerotic, non‐thrombotic coronary disease after thorough histological examination and after excluding other causes of coronary vasculitis and other causes of sudden cardiac death.
Three cases were in previously healthy men aged 31‐51 years whose deaths were sudden and unexpected. Medical histories afforded no clues, nor did gross pathological examinations of the heart and coronary vessels, except in one case. This man had mildly discoloured areas of anterolateral myocardium. Serial sections of his left descending anterolateral artery showed vasculitis through the vessel wall with a cellular infiltrate of CD8+ lymphocytes. In the second case, though the ventricles and coronary arteries on the heart surface appeared normal, serial sections of myocardium and coronary arteries showed a cellular infiltrate of mostly CD4+ and CD8+ lymphocytes in the wall of the small myocardial vessels. In the third, prominent medial and fibrointimal thickening of arteries was evident within the heart. Finally, in a woman aged 45 with severe liver failure who died suddenly during her admission, necropsy showed spontaneous dissection of the left main coronary artery and left anterior descending and circumflex arteries. There was granulation tissue in the left main coronary artery but signs of acute haemorrhage in the other affected arteries, almost blocking the lumen.
Non‐atherosclerotic heart disease is often overlooked as a cause of sudden death.
De Giorgio F, et al. Journal of Clinical Pathology 2007;60:94–97.
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