Coronary artery spasm: Demonstration, definition, diagnosis, and consequences

Pathology of sudden death and clinicopathologic correlations are treated in this chapter. Definition, epidemiology, and pathogenetic mechanisms are first addressed. Sudden death is mostly cardiovascular and arrhythmic in origin, with ventricular fibrillation as the precipitating mechanism of cardiac arrest. The majority of cases present with a pathologic substrate at the level of coronary arteries, myocardium, valves, conduction system, and great arteries. However, there are cases without substrate (ion channel diseases) which require molecular investigations in search of transmissible, genetically determined disease. The chapter is mostly devoted to sudden death in the young, with particular reference to the athletes. Anatomy and pathology of the cardiac conduction system is also dealt with, including ECG correlations. AV block and ventricular preexcitation are taken into detailed consideration. Atrial fibrillation, its causes, substrates, potential complications, and treatment are also extensively treated. Guidelines and useful recommendations for postmortem study of sudden death appear at the end of the chapter.