Is shock the mode of death in SIDS?

Sequential morphological changes as found in the organs of 179 SIDS infants are described. Detailed examination of macroscopic and microscopic heart lesions reveal extensive myocardial lesions which can be best described as selective focal anoxic muscle fibre necrosis at different developmental stages. Varying from case to case the myocardial lesions present themselves in an acute and subacute phases, and in most cases both phases are present at the same time. These lesions are shown to be identical with the myocardial lesions as encountered in shock and many other conditions observed in clinical cases and in experimental laboratory animals. Lesions in other organs are consistent with the effects due to cardiogenic shock. A conclusion is reached that cardiogenic shock leading to acute cardiac failure is the primary final cause of death in all SIDS infants.