Sudden cardiac death caused by coronary ostial compression by an aneurysm of the sinus of valsalva

A 22-year-old man was asymptomatic until he died suddenly after being startled. Post-mortem examination was normal except for aneurysmal dilation of the left Sinus of Valsalva, the upper margin of which formed a flap-like ridge, partially occluding the ostium of the left main coronary artery which arose immediately above it. Further compression of this "slit-like" orifice by aneurysmal distention was the proposed cause of myocardial ischaemia and arrhythmic death (AU)

Cardiac involvement in polymyositis: a clinicopathologic study of 20 autopsied patients

Cardiac involvement in polymyositis was investigated in 20 autopsied cases. Clinically, 13 of 18 patients had abnormal electrocardiograms, and 9 of the 20 patients had previous evidence of congestive heart failure. Histologically documented myocarditis was detected in 6 patients (4 with congestive heart failure and 2 without), 4 of whom also had small vessel disease of the myocardium. Patients with polymyositis may have a cardiopathy in the absence of overt myocardial inflammatory disease. (AU)

Pathology of idiopathic cardiomegaly in Jamaica

Twenty-one cases of idiopathic cardiomegaly which came to necropsy have been reviewed. Investigations included injection and x-ray studies, careful microscopical examination and skip serial sectioning of the conduction systems. The obvious feature was gross cardiomegaly in the absence of atheroma of the large coronary vessels and an associated fibrosis of the right and left bundle-branches. Three hearts showed thickening of the intramural vessels of 80æ to 400æ diameter. We suggest that such changes may be one of the causes of the ischaemic electrocardiographic findings reported in previous epidemiological surveys.(AU)

Prognosis of idiopathic cardiomegaly in Jamaica with reference to the coronary arteries and other factors

Clinical and epidemiological features of idiopathic cardiomegaly in Jamaica are reviewed, and the high community prevalence of the disorder is shown. The frequency occurrence of sudden or unexpected death in patients whose earlier electrocardiograms had shown repeated ventricular ectopic beats has been noted. Common electrocardiographic findings included a high rate of abnormalities usually regarded as indicative of coronary artery disease: cardiac arrhythmias, particularly multiple ventricular extrasystoles; and high voltage complexes characteristic of left ventricular hypertrophy. The differences and similarities between idiopathic cardiomegaly and coronary heart disease are shown. A possible role for intramuscular lignocaine in the control of the chronic ventricular ectopic rhythms is demonstrated. There is a statistically significant association between idiopathic cardiomegaly and positive serological tests for treponemal infection. The hearts are invariably hypertrophied at necropsy. In some hearts the smaller intramuscular coronary arteries show occlusive changes. Their possible nature and significance are discussed.(AU)

Fatty streaks in the coronary arteries and aorta

We have analyzed the extent of fatty streaks in the coronary arteries and aortae of young persons 10 to 39 years old from 19 geographic and ethnic groups. Fatty streaks in the aorta increase rapidly in succeeding age groups during the second decade of life, and in some groups during the third decade. There after they tend to diminish in extent or remain at approximately the same level. Fibrous plaques and other advanced lesions approach similar degrees of extent 20 years or more later. The extent of aortic fatty streaks in youth does not predict the extent of aortic raised lesions later in life on agroup basis. Fatty streaks in the second and the third decades of life, and show no tendency to regress at any age. The mean extent of coronary artery fatty streaks in young persons appears related to the mean extent of raised lesions in the same population at middle age in non-Negro groups. These data are consistent with the hypothesis that advanced atherosclerotic lesions develop by progression and transformation of fatty streaks. However, the degree to which the transformation takes place appears to vary among arteries and among racial groups. (AU)

Histologic characteristics of coronary artery fatty streaks

The histologic characterictics of a standard site in the left interior descending coronary artery of 304 males between 10 and 39 years of age from seven different populations were examined. These seven location-race groups were ranked in the same order as the ranking based upon mean extent of raised atherosclerotic lesions in the coronary arteries and aorta to establish the tendency of each group to develop advanced atherosclerosis. Muscloelastic intimal thickening in the earlier decades does not predict the likelihood to develop severe atherosclerosis. Amount of intimal lipid and degree of cellular infiltration do predict the disposition to develop severe atherosclerosis later in life. Therefore, increased intimal lipid and cellular infiltration characterize coronary artery fatty streaks that are associated with their conversion to fibrous plaques. Necrosis of lipid-containing cells may release intracellular lipid into the extracellular space and thereby incite cellular infiltration and sequelae. (AU)

Atherosclerosis in persons with selected diseases

Comparison has been made of measures of coronary and aortic atherosclerosis in autopsied persons having five selected diseases (lung cancer,stomach cancer, other cancer, cirrhosis of the liver, and tuberculosis) with similar measures in control cases. There appears to be a slight but not significant tendency for lung cancer to be associated with more severe atherosclerosis within age-location-race subgroups. The tendency is strongest in the abdominal aorta. None of the other four diseases appears to be associated with increased or decreased severity of atherosclerosis in comparison with the control groups.(AU)

Distribution of coronary and aortic atherosclerosis by geographic location, race, and sex

Cooperating pathologists in different countries collected 23,207 sets of coronary arteries and aortae, according to a standard protocol. A central laboratry staff stained the arteries with Sudan IV, and a team of pathologists graded the atherosclerotic lesions. A basal group of cases which died from accidents, infections, cancer, and selected miscellaneous causes was extracted in order to compare atherosclerosis among the different geographic, racial, and sex subgroups. Even the most homogeneous subgroups (same location, sex, age, and race) vary greatly in extent of advanced atherosclerotic lesions. The 19 location-race groups differ significantly in extent of raised lesions. The abdominal aorta and the left anterior descending coronary artery have more atherosclerosis than other arteries. Within most location-race groups, coronary arteries of men have more raised lesions than the coronary arteries of women. Aortae of men in some groups have slightly more, and in other groups slightly less raised lesions than the aortae of women. Negro groups show little or no sex difference in either the coronary arteries or the aorta. Ranking of the 19 location-race groups by raised atherosclerotic lesions is similar, regardless of lesion measure (fatty streaks excepted), sex, artery, or age group. New Orleans white and the Oslo group rank highest; Bogota, Sao Paulo Negro, Guatemala, and Durban Bantu groups rank lowest. With few exceptions, ranking these groups by raised lesions corresponds closely with ranking them by coronary heart disease mortality rate. (AU)

Some factors influencing the development of atherosclerosis: A survey in Jamaica, West Indies

Using a quantitative method of assay the degree of atherosclerosis of the aorta, coronary arteries and cerebral arteries has been determined in a large, predominantly Negro, autopsy series in Jamaica, West Indies. There is a progressive worsening of the disease with age but there are considerable individual variations at all ages. The aorta, coronary and cerebral arteries are affected in that order in time and severity. Atherosclerosis is generally more severe in men and hypertension accentuates the disease, especially in women after the menopause. Hypertension is more important than atherosclerosis in causing cerebrovascular disease in Jamaica. Diabetes alone does not seem to influence adversely the development of atherosclerosis except in combination with hypertension. Evidence for the effect of malignant disease was inconclusive. Severe degrees of atherosclerosis are encountered in the Jamaican Negro but the supposed complications are relatively uncommon. This supports the view that factors other than initial disease, principally those connected with thrombosis, are concerned in the pathogenesis of ischaemic vascular disease. (AU)