Pathophysiology of Sudden Coronary Death in Women

Despite major progress in detection, prevention, and treatment, coronary artery disease remains the leading cause of death in the world. More than half of all coronary deaths are sudden and unexpected, occurring within 6 hours of the onset of symptoms and usually outside the hospital.1 Coronary artery disease is by far the most common pathology underlying the 300 000 cases of sudden cardiac death occurring in the United States each year.2 The insidious nature of sudden cardiac death and the finality of the outcome represent major barriers to development of effective preventative and therapeutic strategies. This is a particular problem in women, in whom the risk of coronary artery disease and of sudden death is lower than in men and in whom the index of suspicion of serious cardiovascular pathology remains low. Data from carefully conducted postmortem studies of victims of sudden cardiac death provide important insights into the pathogenesis of sudden cardiac death and the risk factors that predispose to it.In a study reported in the current issue of Circulation , Burke et al relate cardiac pathology in 51 female victims of sudden death identified at the Office of the Chief Medical Examiner of the State of Maryland to antecedent symptoms and cardiac risk factors and compare these to findings in 15 female victims of fatal trauma as control subjects.3 Several striking findings emerge from the study: (1) Of the 36 deaths that were witnessed, only 8 (22%) were preceded by chest pain; 12 (33%) were preceded by other, nonspecific symptoms, including back pain, dizziness, nausea and vomiting, shortness of breath, malaise, fatigue, fever and chills, stomach distension, and tingling of the left shoulder; and 16 (45%) were preceded by no symptoms whatsoever. (2) Only one patient was receiving hormone replacement therapy. (3) Coronary anatomy …