Emedinews:Insights on Medicolegal Issues:Right coronary artery supplying blood to the electrical area of heart is called artery of sudden death

• The most common cause of sudden cardiac death in adults over the age of 40 has been coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in the mortuary of AIIMS.
• 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 75 out of hundred cases, the clot was 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 are seen during postmortem examination.
• The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
• 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.