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Non-atherosclerotic coronary artery disease associated with sudden cardiac death
Sharleen F Hill1, Mary N Sheppard
1Imperial College London, UK.
Insights
Non-atherosclerotic coronary artery disease is an underrecognized cause of sudden cardiac death (SCD), particularly in younger males. Awareness is crucial for early detection and prevention in patients with cardiac symptoms.
Area of Science:
- Cardiovascular Pathology
- Sudden Cardiac Death Etiologies
- Forensic Cardiology
Background:
- Non-atherosclerotic coronary artery pathology is an underappreciated cause of sudden cardiac death (SCD).
- Limited attention has been given to these conditions in existing literature.
- This study aims to highlight their significance.
Purpose of the Study:
- To determine the incidence of non-atherosclerotic coronary artery pathology in sudden cardiac death (SCD).
- To increase awareness among cardiologists and pathologists regarding these conditions.
- To emphasize the importance of considering non-atherosclerotic causes in SCD investigations.
Main Methods:
- Retrospective analysis of 1647 cases of sudden cardiac death (SCD) over a 14-year period (1994-2008).
- Cardiac pathology assessments were conducted to determine the precise etiology of SCD.
- Inclusion criteria focused on cases with non-atherosclerotic coronary artery findings.
Main Results:
- Fifty cases (3.0%) of SCD were attributed to non-atherosclerotic coronary pathology.
- Common findings included anomalous coronary arteries (48%), coronary artery dissection (16%), and vasculitis (12%).
- Symptoms prior to SCD were present in 40% of cases, with 24% dying during or after physical exertion.
Conclusions:
- Non-atherosclerotic coronary disease is a significant factor in sudden cardiac death across all age groups, especially in younger males.
- Cardiologists must be vigilant for these pathologies, particularly in patients presenting with cardiac symptoms, especially exertional symptoms.
- Further investigation into non-atherosclerotic causes is warranted for comprehensive SCD management.
Background:
The concept of non-atherosclerotic coronary artery pathology in sudden cardiac death (SCD) has not been given the attention it deserves.
Objective:
To determine the incidence of non-atherosclerotic coronary artery pathology in SCD and raise awareness among cardiologists and pathologists alike.
Design:
Retrospective non-case-controlled analysis. Setting Cardiac pathology centre at the National Heart and Lung Institute and Royal Brompton Hospital.
Subjects:
Between 1994 and 2008, the hearts of 1647 people undergoing SCD were referred for pathological assessment to ascertain the precise aetiology of SCD.
Results:
Fifty (3.0%) of the 1647 cases of SCD were associated with non-atherosclerotic coronary pathology (31 male subjects (62%) and 19 female subjects (38%, age range (8 weeks-71 years)). Twenty four of the 50 cases had anomalous coronary arteries (48%); eight cases had coronary artery dissection (16%); six cases had coronary artery vasculitis (12%); six cases had coronary artery spasm (12%); three cases had idiopathic arterial calcification of infancy (6%); two cases had fibromuscular dysplasia (4%) and one case had a benign tumour occluding the left coronary ostium (2%). Only 20 of the 50 patients (40%) were documented to have experienced cardiac symptoms such as syncope, chest pain on exertion or breathlessness before their SCD. Twelve of the patients (24%) died during or immediately after physical exertion.
Conclusion:
Non-atherosclerotic coronary disease is associated with sudden death in all age groups, particularly younger, male patients. Cardiologists need to be aware of these entities and investigate any patient who has cardiac symptoms especially with exertion.
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