De Subitaneis Mortibus

Two cases of sudden death are described, a boy of 16 and a woman of 34. Both had marked narrowing of the atrioventricular (A-V) node artery and fibrosis in the His bundle. Whereas he had been known to have complete heart block for several years, she was thought to be in excellent health until her sudden unexpected death. The degree of fibrosis in his His bundle was so extensive that one can doubt any effective transmission of a sinus impulse. Her His bundle was much less involved, but this may have been the consequence of her death during an initial mal-function of this crucial region of the heart, whereas prolonged survival of the boy (by electronic pacing) permitted a final view of the later histological consequences of the same initial arterial lesion. Both also had a mild degree of myocarditis and narrowing of a few other small coronary arteries (the large ones were normal). The possible functional inter-relationship of these factors is discussed.