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Circulation, Vol 87, 1442-1450, Copyright © 1993 by American Heart Association
SN Willich, M Maclure, M Mittleman, HR Arntz and JE Muller
Epidemiological studies have identified associations between time of day
and risk of sudden cardiac death. The marked peak in the occurrence of
sudden cardiac death after awakening suggests that the disease is triggered
by changes that occur during this time period. Increased sympathetic
stimulation is a likely cause of such triggering. In the light of the
circadian variation of sudden cardiac death and the evidence linking
physical activity or mental stress (both associated with activation of the
sympathetic nervous system) to the disease, the role of potential
triggering events should be investigated. Controlled studies are needed to
determine the relative risk of activities that may trigger sudden cardiac
death. Since such studies must rely on witnesses (or resuscitated
patients), data quality must be closely scrutinized, and studies using
case-control and case-crossover designs are needed. The epidemiological and
pathophysiological data reviewed in the present article suggest a number of
pathways through which activities may trigger sudden cardiac death.
Different extrinsic stimuli may cause similar physiological changes that
subsequently lead to acute pathological events, a decrease in the
ventricular fibrillation threshold through a direct myocardial effect, or a
harmful effect on the conduction system. Myocardial ischemia induced by
plaque rupture and thrombosis may lead directly to myocardial electric
instability. The presence of chronic structural abnormalities of the
myocardial tissue or the conduction system may further lower the threshold
for electric instability and ventricular fibrillation.(ABSTRACT TRUNCATED
AT 250 WORDS)
ARTICLES
Sudden cardiac death. Support for a role of triggering in causation
Klinikum Steglitz, Free University of Berlin, FRG.
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