[Cor bovinum: decreased incidence over the last 20 years--a therapeutic success?]

The Cor bovinum (CB), a heart of > 500 g, is often found in patients with clinically unclear cause of death. Cardiomyocyte hypertrophy and increase of the interstitial connective tissue can lead to electromechanical instability and consecutive sudden heart death.

This retrospective, autopsy-protocol-based study compared the frequency of altogether 415 CB and associated pathologies in two 4-year periods (1978-1981 and 1997-2000), including only patients of the Clinic of Internal Medicine (n = 1181 autopsies).

A CB was found in 25.3% of the patients of the first period (1978-1981) in contrast of 20.6% in the second period (1997-2000); hence, the frequency of CB is decreasing (0.05 > p > 0.02). The mean age at death was 67.7 years in 1978-1981 and 74.3 years in 1997-2000; this revealed an increasing trend (p < 0.001). The male-female proportion was 4:1. In 93% of all patients with CB, we found coronary atherosclerosis as a sign of high blood pressure and in 79% a COPD. In 84% of all cases with CB the cause of death was directly related to the CB, in 37% of these patients the cause of death was clinically unclear.

The CB is a decreasing but still frequent autopsy-finding. We consider high blood pressure, COPD and male sex as the main risk factors. The decrease in frequency of CB and the increase in age at death might be interpreted as the effect of a successful application of new therapeutic standards in the last two decades (ACE-inhibitors, beta blockers, statins, PTCA, surgical heart interventions).