The most common cause of sudden cardiac death in adults over the age of 40 seen in postmortem examination in approximately 100 cases randomly selected by me in the mortuary at AIIMS has been coronary artery atheroma.
• The most common finding at postmortem examination is chronic high-grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply.
• A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
• In many cases out of hundreds, the clots were found in the right coronary artery supplying the electrical area of heart.
• Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium is seen during postmortem examination.
• The absence of the histological signs of acute necrosis and a healed infarct are common findings.
• Chronic high-grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
• Ventricular arrhythmias may arise from a myocardium, which has been previously scarred by episodes of ischemia.
(Contributed by Dr Sudhir Gupta)
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