Pathology of Sudden Death in Coronary Arterial Diseases

  • Shannon M. Mackey-Bojack
  • Emily R. Duncanson
  • Susan J. Roe


Most cases of sudden unexpected death are cardiac in nature, and the majority are related to coronary artery disease. While atherosclerotic coronary artery disease is the most common cause of sudden unexpected death in the United States, nonatherosclerotic coronary artery diseases are an important cause of sudden unexpected death, especially in the young. This chapter describes causes of sudden death related to both categories of coronary artery disease.


Sudden Death Leave Anterior Descend Sudden Cardiac Death Kawasaki Disease Right Coronary Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Thiene G, Basso C, Corrado D. Cardiovascular causes of sudden death. In: Silver M, Gotlieb A, Schoen F, editors. Cardiovascular pathology. 3rd ed. Philadelphia: Churchill Livingstone; 2001. p. 326–74.Google Scholar
  2. 2.
    Langlois N. Sudden adult death. Forensic Sci Med Pathol. 2009;5:210–32.PubMedCrossRefGoogle Scholar
  3. 3.
    Virmani R, Burke A, Farb A. Sudden cardiac death. Cardiovasc Pathol. 2001;10:211–8.PubMedCrossRefGoogle Scholar
  4. 4.
    Myerburg R, Castellanos A. Cardiac arrest and sudden cardiac death. In: Braunwald E, editor. Braunwald heart disease. 5th ed. Philadelphia: W.B. Saunders Company; 1997. p. 742–56.Google Scholar
  5. 5.
    Virmani R, Burke A, Farb A, et al. Problems in forensic cardiovascular pathology. In: Schoen F, editor. Cardiovascular pathology: clinicopathologic correlations and pathogenetic mechanisms. Philadelphia: Williams & Wilkins; 1995. p. 173–93.Google Scholar
  6. 6.
    Gillum R. Sudden coronary death in the United States, 1980–1985. Circulation. 1989;79:756–65.PubMedCrossRefGoogle Scholar
  7. 7.
    Liberthson R. Sudden death from cardiac causes in children and young adults. N Engl J Med. 1996;334:1039–44.PubMedCrossRefGoogle Scholar
  8. 8.
    Driscoll D, Edwards W. Sudden unexpected death in children and adolescents. J Am Coll Cardiol. 1985;5:118B–21.PubMedCrossRefGoogle Scholar
  9. 9.
    Corrado D, Thiene G, Cocco P, et al. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J. 1992;68:601–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Edwards BS, Edwards JE. Atherosclerotic coronary disease. Pathology of sudden death. Malden: Blackwell Futura; 2006. p. 1–25.CrossRefGoogle Scholar
  11. 11.
    Virmani R, Burke AP, Farb A. Sudden cardiac death. Cardiovasc Pathol. 2001;10:275–82.PubMedCrossRefGoogle Scholar
  12. 12.
    Kumar V, Abbas AK, Fausto N, editors. The heart. In: Robbins and Cotran pathologic basis of disease. 7th ed. Philadelphia: Elsevier Saunders; 2005. p. 571–86.Google Scholar
  13. 13.
    DiMaio V, DiMaio D. Incidence of coronary thrombosis in sudden death due to coronary artery disease. Am J Forensic Med Pathol. 1993;14:273–5.CrossRefGoogle Scholar
  14. 14.
    Warnes CA, Roberts WC. Sudden coronary death: comparison of patients with to those without coronary thrombus at necropsy. Am J Cardiol. 1984;54:1206–11.PubMedCrossRefGoogle Scholar
  15. 15.
    Shirani J, Berezowski K, Roberts WC. Out of hospital sudden death from left ventricular free wall rupture during acute myocardial infarction as the first and only manifestation of atherosclerotic coronary artery disease. Am J Cardiol. 1994;73:88–92.PubMedCrossRefGoogle Scholar
  16. 16.
    Wilansky S, Moreno CA, Lester SJ. Complications of myocardial infarction. Crit Care Med. 2007;35:S348–54.PubMedCrossRefGoogle Scholar
  17. 17.
    Basso C, Corrado D, Thiene G. Congenital coronary artery anomalies as an important cause of sudden death in the young. Cardiol Rev. 2001;9:312–7.PubMedCrossRefGoogle Scholar
  18. 18.
    Taylor A, Rogan K, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992;20:640–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115:1296–305.PubMedGoogle Scholar
  20. 20.
    Basso C, Maron B, Corrado D, et al. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:493–501.CrossRefGoogle Scholar
  21. 21.
    Taylor A, Byers J, Cheitlin M, et al. Anomalous right or left coronary artery from the contralateral coronary sinus: “high-risk” abnormalities in the initial coronary artery course and heterogeneous clinical outcomes. Am Heart J. 1997;133:428–35.PubMedCrossRefGoogle Scholar
  22. 22.
    Davis J, Cecchin F, Jones T, et al. Major coronary artery anomalies in a pediatric population: incidence and clinical importance. J Am Coll Cardiol. 2001;37:593–7.PubMedCrossRefGoogle Scholar
  23. 23.
    Frescura C, Basso C, Thiene G, et al. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998;29:689–95.PubMedCrossRefGoogle Scholar
  24. 24.
    Roberts W. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1985;111:941–63.CrossRefGoogle Scholar
  25. 25.
    Vlodaver Z, Neufeld H, Edwards J. Coronary arterial variations in the normal heart and in congenital heart disease. New York: Academic; 1975. p. 23–35.Google Scholar
  26. 26.
    Pretty HC. Dissecting aneurysm of coronary artery in a woman aged 42: rupture. Br Med J. 1931;1:667.CrossRefGoogle Scholar
  27. 27.
    Dhawan R, Singh G, Fesniak H. Spontaneous coronary artery dissection: the clinical spectrum. Angiology. 2002;53:89–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Lodha A, Mirsakov N, Malik B, et al. Spontaneous coronary artery dissection: case report and review of literature. South Med J. 2009;102:315–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Terrovitis J, Kanakakis J, Nanas J. Spontaneous coronary artery dissection as a cause of acute myocardial infarction in the postpartum period. Cardiol Rev. 2005;13(4):211–3.PubMedCrossRefGoogle Scholar
  30. 30.
    DeMaio S, Kinsella S, Silverman M. Clinical course and long-term prognosis of spontaneous coronary artery dissection. Am J Cardiol. 1989;64:471–4.PubMedCrossRefGoogle Scholar
  31. 31.
    Claudon DG, Claudon DB, Edwards J. Primary dissecting aneurysm of coronary artery a cause of acute myocardial ischemia. Circulation. 1972;45:259–66.PubMedCrossRefGoogle Scholar
  32. 32.
    Koul A, Hollander G, Moskovits N, et al. Coronary artery dissection during pregnancy and the postpartum period: two case reports and review of literature. Catheter Cardiovasc Interv. 2001;52:88–94.PubMedCrossRefGoogle Scholar
  33. 33.
    Jorgensen M, Aharonian V, Mansukhani P, et al. Spontaneous coronary dissection: a cluster of cases with this rare finding. Am Heart J. 1994;127:1382–7.PubMedCrossRefGoogle Scholar
  34. 34.
    Steinhauer J, Caulfield J. Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovasc Pathol. 2001;10:141–5.PubMedCrossRefGoogle Scholar
  35. 35.
    Freeman AF, Shulman ST. Recent developments in Kawasaki disease. Curr Opin Infect Dis. 2001;14:357.PubMedCrossRefGoogle Scholar
  36. 36.
    Burke A, Virmani R, Lowell P, et al. Fatal Kawasaki disease with coronary arteritis and no coronary aneurysms. Am Acad Pediatr. 1998;101:108–12.Google Scholar
  37. 37.
    Maresi E, Passantino R, Midulla R, et al. Sudden infant death caused by ruptured coronary aneurysm during acute phase of atypical Kawasaki disease. Hum Pathol. 2001;32:1407–9.PubMedCrossRefGoogle Scholar
  38. 38.
    Rav-Acha M, Plot L, Peled N, et al. Coronary involvement in Takayasu’s arteritis. Autoimmun Rev. 2007;6:566–71.PubMedCrossRefGoogle Scholar
  39. 39.
    Ohno H, Matsuda Y, Takashiba K, et al. Acute myocardial infarction in Buerger’s disease. Am J Cardiol. 1986;57:690.PubMedCrossRefGoogle Scholar
  40. 40.
    Donatelli F, Triggiani M, Nascimbene S, et al. Thromboangiitis obliterans of coronary and internal thoracic arteries in a young woman. J Thorac Cardiovasc Surg. 1997;113:800.PubMedCrossRefGoogle Scholar
  41. 41.
    James T. Morphologic characteristics and functional significance of focal fibromuscular dysplasia of small coronary arteries. Am J Cardiol. 1990;65:12G–22.PubMedCrossRefGoogle Scholar
  42. 42.
    Maresi E, Becchina G, Ottoveggio G, et al. Arrhythmic sudden cardiac death in a 3-year-old child with intimal fibroplasia of coronary arteries, aorta, and its branches. Cardiovasc Pathol. 2001;9:43–8.CrossRefGoogle Scholar
  43. 43.
    Imamura M, Yokoyama S, Kikuchi K. Coronary fibromuscular dysplasia presenting as sudden infant death. Arch Pathol Lab Med. 1997;121:159–61.PubMedGoogle Scholar
  44. 44.
    Kaneko K, Someya T, Ohtaki R, et al. Congenital fibromuscular dysplasia involving multivessels in an infant with fatal outcome. Eur J Pediatr. 2004;163:241–4.PubMedCrossRefGoogle Scholar
  45. 45.
    Lee A, Gray P, Gallagher P. Sudden death and regional left ventricular fibrosis with fibromuscular dysplasia of small intramyocardial coronary arteries. Heart. 2000;83:101–2.PubMedCrossRefGoogle Scholar
  46. 46.
    Burke A, Virmani R. Intramural coronary artery dysplasia of the ventricular septum and sudden death. Hum Pathol. 1998;29:1124–7.PubMedCrossRefGoogle Scholar
  47. 47.
    Morales A, Romanelli R, Boucek R, et al. Myxoid heart disease: an assessment of extravalvular cardiac pathology in severe mitral valve prolapse. Hum Pathol. 1992;23:129–37.PubMedCrossRefGoogle Scholar
  48. 48.
    Burke A, Farb A, Tang A, et al. Fibromuscular dysplasia of small coronary arteries and fibrosis in the basilar ventricular septum in mitral valve prolapse. Am Heart J. 1997;134:282–91.PubMedCrossRefGoogle Scholar
  49. 49.
    Maron B, Wolfson J, Epstein S, et al. Intramural (small vessel) coronary artery disease in hypertrophic cardiomyopathy. J Am Coll Cardiol. 1986;8:545–57.PubMedCrossRefGoogle Scholar
  50. 50.
    Zack F, Terpe H, Hammer U, et al. Fibromuscular dysplasia of coronary arteries as a rare cause of death. Int J Legal Med. 1996;108:215–8.PubMedCrossRefGoogle Scholar
  51. 51.
    Burke A, Subramanian R, Smialek J, et al. Nonatherosclerotic narrowing of the atrioventricular node artery and sudden death. J Am Coll Cardiol. 1993;21:117–22.PubMedCrossRefGoogle Scholar
  52. 52.
    Kim P, Hur G, Kim S, et al. Frequency of myocardial bridges and dynamic compression of epicardial coronary arteries: a comparison between computed tomography and invasive coronary angiography. Circulation. 2009;119:1408–16.PubMedCrossRefGoogle Scholar
  53. 53.
    Möhlenkamp S, Hort W, Ge J, et al. Update on myocardial bridging. Circulation. 2002;106:2616–22.PubMedCrossRefGoogle Scholar
  54. 54.
    Boktor M, Mansi I, Troxclair S, et al. Association of myocardial bridge and Takotsubo cardiomyopathy: a case report and literature review. South Med J. 2009;102:957–60.PubMedCrossRefGoogle Scholar
  55. 55.
    Morales AR, Romanelli R, Boucek RJ. The mural left anterior descending coronary artery, strenuous exercise and sudden death. Circulation. 1980;62:230–7.PubMedCrossRefGoogle Scholar
  56. 56.
    Ishikawa Y, Akasaka Y, Suzuki K, et al. Anatomic properties of myocardial bridge predisposing to myocardial infarction. Circulation. 2009;120:376–83.PubMedCrossRefGoogle Scholar
  57. 57.
    Edwards B, Edwards J. Nonatherosclerotic coronary artery disease. In: Malden MA, editor. Sudden cardiac death. Malden: Blackwell Futura; 2006. p. 27.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Shannon M. Mackey-Bojack
    • 1
  • Emily R. Duncanson
    • 1
  • Susan J. Roe
    • 1
  1. 1.Department of Jesse E. Edwards Registry of Cardiovascular DiseaseUnited HospitalSt. PaulUSA

Personalised recommendations