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Coronary Artery Disease

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Sudden Cardiac Death in the Young and Athletes

Abstract

Sudden cardiac death (SCD) is mostly ascribable to coronary artery disease and is due to a large spectrum of both congenital and acquired morbid entities [1–3]. Premature coronary atherosclerosis is ranking first even in young age, with peculiar features of an accelerated proliferative phenomenon [2, 4].

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References

  1. Davies MJ. The investigation of sudden cardiac death. Histopathology. 1999;34:93–8.

    Article  CAS  PubMed  Google Scholar 

  2. Thiene G, Carturan E, Corrado D, Basso C. Prevention of sudden cardiac death in the young and in athletes: dream or reality? Cardiovasc Pathol. 2010;19:207–17.

    Article  PubMed  Google Scholar 

  3. Fishbein MC. Cardiac disease and risk of sudden death in the young: the burden of the phenomenon. Cardiovasc Pathol. 2010;19:326–8.

    Article  PubMed  Google Scholar 

  4. Corrado D, Basso C, Poletti A, Angelini A, Valente M, Thiene G. Sudden death in the young: is coronary thrombosis the major precipitating factor? Circulation. 1994;90:2315–23.

    Article  CAS  PubMed  Google Scholar 

  5. Davies MJ, Thomas A. Thrombosis and acute coronary-artery lesions in sudden cardiac ischemic death. N Engl J Med. 1984;310:1137–40.

    Article  CAS  PubMed  Google Scholar 

  6. Davies MJ. Stability and instability: the two faces of coronary atherosclerosis. The Paul Dudley White Lecture, 1995. Circulation. 1996;94:2013–20.

    Google Scholar 

  7. Falk E, Nakano M, Bentzon JF, Finn AV, Virmani R. Update on acute coronary syndromes: the pathologists’ view. Eur Heart J. 2013;34:719–28.

    Article  CAS  PubMed  Google Scholar 

  8. Falk E. Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death: autopsy evidence of recurrent mural thrombosis with peripheral embolization culminating in total vascular occlusion. Circulation. 1985;71:699–708.

    Article  CAS  PubMed  Google Scholar 

  9. Henriques de Gouveia R, van der Wal AC, van der Loos CM, Becker AE. Sudden unexpected death in young adults. Discrepancies between initiation of acute plaque complications and the onset of acute coronary death. Eur Heart J. 2002;23:1433–40.

    Google Scholar 

  10. Kragel AH, Gertz SD, Roberts WC. Morphologic comparison of frequency and types of acute lesions in the major epicardial coronary arteries in unstable angina pectoris, sudden coronary death and acute myocardial infarction. J Am Coll Cardiol. 1991;18:801–8.

    Article  CAS  PubMed  Google Scholar 

  11. Ip JH, Fuster V, Badimon L, Badimon J, Taubman MB, Chesebro JH. Syndromes of accelerated atherosclerosis: role of vascular injury and smooth muscle cell proliferation. J Am Coll Cardiol. 1990;15:1667–87.

    Article  CAS  PubMed  Google Scholar 

  12. Flugelman MY, Virmani R, Correa R, Yu ZX, Farb A, Leon MB, Elami A, Fu YM, Casscells W, Epstein SE. Smooth muscle cell abundance and fibroblast growth factors in coronary lesions of patients with nonfatal unstable angina: a clue to the mechanism of transformation from the stable to the unstable clinical state. Circulation. 1993;88:2493–500.

    Article  CAS  PubMed  Google Scholar 

  13. Tavora F, Cresswell N, Li L, Ripple M, Fowler D, Burke A. Sudden coronary death caused by pathologic intimal thickening without atheromatous plaque formation. Cardiovasc Pathol. 2011;20:51–7.

    Article  PubMed  Google Scholar 

  14. Corrado D, Thiene G, Buja GF, Pantaleoni A, Maiolino P. The relationship between growth of atherosclerotic plaques, variant angina and sudden death. Int J Cardiol. 1990;26:361–7.

    Article  CAS  PubMed  Google Scholar 

  15. Larsen MK, Nissen PH, Kristensen IB, Jensen HK, Banner J. Sudden cardiac death in young adults: environmental risk factors and genetic aspects of premature atherosclerosis. J Forensic Sci. 2012;57:658–62.

    Article  CAS  PubMed  Google Scholar 

  16. van der Wal AC, Becker AE, van der Loos CM, Das PK. Site of intimal rupture or erosion of thrombosed coronary atherosclerotic plaques is characterized by an inflammatory process irrespective of the dominant plaque morphology. Circulation. 1994;89:36–44.

    Article  PubMed  Google Scholar 

  17. Farb A, Burke AP, Tang AL, Liang TY, Mannan P, Smialek J, Virmani R. Coronary plaque erosion without rupture into a lipid core. A frequent cause of coronary thrombosis in sudden coronary death. Circulation. 1996;93:1354–63.

    Article  CAS  PubMed  Google Scholar 

  18. Calabrese F, Basso C, Valente M, Thiene G. Coronary thrombosis and sudden death after an enteroviral infection. APMIS. 2003;111:315–8.

    Article  PubMed  Google Scholar 

  19. Maseri A, Chierchia S. Coronary artery spasm: demonstration, definition, diagnosis and consequences. Prog Cardiovasc Dis. 1982;25:169–92.

    Article  CAS  PubMed  Google Scholar 

  20. Myerburg RJ, Kessler KM, Mallon SM, Cox MM, deMarchena E, Interian Jr A, Castellanos A. Life-threatening ventricular arrhythmia in patients with silent myocardial ischemia due to coronary artery spasm. N Engl J Med. 1992;326:1451–5.

    Article  CAS  PubMed  Google Scholar 

  21. Lucena J, Blanco M, Jurado C, Rico A, Salguero M, Vazquez R, Thiene G, Basso C. Cocaine-related sudden death: a prospective investigation in south-west Spain. Eur Heart J. 2010;31:318–29.

    Article  CAS  PubMed  Google Scholar 

  22. Montisci M, Thiene G, Ferrara SD, Basso C. Cannabis and cocaine: a lethal cocktail triggering coronary sudden death. Cardiovasc Pathol. 2008;17:344–6.

    Article  CAS  PubMed  Google Scholar 

  23. Warnes CA, Roberts WC. Sudden coronary death: relation of amount and distribution of coronary narrowing at necropsy to previous symptoms of myocardial ischemia, left ventricular scarring and heart weight. Am J Cardiol. 1984;54:65–73.

    Article  CAS  PubMed  Google Scholar 

  24. Davies MJ. Anatomic features in victims of sudden coronary death. Coronary artery pathology. Circulation. 1992;85(1 Suppl):I19–24.

    CAS  PubMed  Google Scholar 

  25. Liberthson RR, Nagel EL, Hirschman JC, Nussenfeld SR. Prehospital ventricular fibrillation: prognosis and follow-up course. N Engl J Med. 1974;29:317–21.

    Article  Google Scholar 

  26. Liberthson RR, Nagel EL, Hirshman JC, Nussenfeld SR, Blackbourne BD, Davis JR. Pathophysiologic observations in prehospital ventricular fibrillation and sudden cardiac death. Circulation. 1974;49:790–8.

    Article  CAS  PubMed  Google Scholar 

  27. Lovergrove T, Thompson P. The role of acute myocardial infarction in sudden cardiac death: a statistician's nightmare. Am Heart J. 1978;96:711–3.

    Article  Google Scholar 

  28. Myerburg RJ, Conde CA, Sung RJ, Mayorga-Cortes A, Mallon SM, Sheps DS, Appel RA, Castellanos A. Clinical, electrophysiologic, and hemodynamic profile of patients resuscitated from prehospital cardiac arrest. Am J Med. 1980;68:568–75.

    Article  CAS  PubMed  Google Scholar 

  29. Bezzina CR, Pazoki R, Bardai A, Marsman RF, de Jong JS, Blom MT, Scicluna BP, Jukema JW, Bindraban NR, Lichtner P, Pfeufer A, Bishopric NH, Roden DM, Meitinger T, Chugh SS, Myerburg RJ, Jouven X, Kääb S, Dekker LR, Tan HL, Tanck MW, Wilde AA. Genome-wide association study identifies a susceptibility locus at 21q21 for ventricular fibrillation in acute myocardial infarction. Nat Genet. 2010;42:688–91.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  30. Corrado D, Thiene G, Cocco P, Frescura C. Non-atherosclerotic coronary artery disease and sudden death in the young. Br Heart J. 1992;68:601–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Hill SF, Sheppard MN. Non-atherosclerotic coronary artery disease associated with sudden cardiac death. Heart. 2010;96:1119–25.

    Article  PubMed  Google Scholar 

  32. Thiene G, Basso C. Sudden coronary death–not always atherosclerotic. Heart. 2010;96:1084–5.

    Article  PubMed  Google Scholar 

  33. Basso C, Thiene G, Dalla Volta S. Coronary embolism: a frequently forgotten cause of myocardial infarct and sudden death. G Ital Cardiol. 1992;22:751–60.

    CAS  PubMed  Google Scholar 

  34. Basso C, Valente M, Thiene G. Cardiac tumor pathology. New York: Springer Humana Press; 2013 edition.

    Google Scholar 

  35. Valente M, Basso C, Thiene G, Bressan M, Stritoni P, Cocco P, Fasoli G. Fibroelastic papilloma: a not-so-benign cardiac tumor. Cardiovasc Pathol. 1992;1:161–6.

    Article  CAS  PubMed  Google Scholar 

  36. Basso C, Bottio T, Valente M, Bonato R, Casarotto D, Thiene G. Primary cardiac valve tumours. Heart. 2003;89:1259–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Bussani R, Silvestri F. Sudden death in a woman with fibroelastoma of the aortic valve chronically occluding the right coronary ostium. Circulation. 1999;100:2204.

    Article  CAS  PubMed  Google Scholar 

  38. Byramji A, Gilbert JD, Byard RW. Sudden death as a complication of bacterial endocarditis. Am J Forensic Med Pathol. 2011;32:140–2.

    Article  PubMed  Google Scholar 

  39. Burns JC, Shike H, Gordon JB, Malhotra A, Schoenwetter M, Kawasaki T. Sequelae of Kawasaki disease in adolescents and young adults. J Am Coll Cardiol. 1996;28:253–7.

    Article  CAS  PubMed  Google Scholar 

  40. Daniels LB, Gordon JB, Burns JC. Kawasaki disease: late cardiovascular sequelae. Curr Opin Cardiol. 2012;27:572–7.

    Article  PubMed  Google Scholar 

  41. Shimizu C, Sood A, Lau HD, Oharaseki T, Takahashi K, Krous HF, Campman S, Burns JC. Cardiovascular pathology in 2 young adults with sudden, unexpected death due to coronary aneurysms from Kawasaki disease in childhood. Cardiovasc Pathol. 2015;24:310–6.

    Google Scholar 

  42. Cohle SD, Titus JL, Espinola A, Jachimczyk JA. Sudden unexpected death due to coronary giant cell arteritis. Arch Pathol Lab Med. 1982;106:171–2.

    CAS  PubMed  Google Scholar 

  43. Basso C, Baracca E, Zonzin P, Thiene G. Sudden cardiac arrest in a teenager as first manifestation of Takayasu’s disease. Int J Cardiol. 1994;43:87–9.

    Article  CAS  PubMed  Google Scholar 

  44. Basso C, Morgagni GL, Thiene G. Spontaneous coronary artery dissection: a neglected cause of acute myocardial ischaemia and sudden death. Heart. 1996;75:451–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Rizzo S, Corrado D, Thiene G, Basso C. Sudden cardiac death in women. G Ital Cardiol. 2012;13:432–9.

    Google Scholar 

  46. Tweet MS, Hayes SN, Pitta SR, Simari RD, Lerman A, Lennon RJ, Gersh BJ, Khambatta S, Best PJ, Rihal CS, Gulati R. Clinical features, management, and prognosis of spontaneous coronary artery dissection. Circulation. 2012;126:579–88.

    Article  PubMed  Google Scholar 

  47. Desai S, Sheppard MN. Sudden cardiac death: look closely at the coronaries for spontaneous dissection which can be missed. A study of 9 cases. Am J Forensic Med Pathol. 2012;33:26–9.

    Article  PubMed  Google Scholar 

  48. Robinowitz M, Virmani R, McAllister HA JrU. Spontaneous coronary artery dissection and eosinophilic inflammation: a cause and effect relationship? Am J Med. 1982;72:923–8.

    Google Scholar 

  49. Dowling GP, Buja LM. Spontaneous coronary artery dissection occurs with and without periadventitial inflammation. Arch Pathol Lab Med. 1987;111:470–2.

    CAS  PubMed  Google Scholar 

  50. Steinhauer JR, Caulfield JB. Spontaneous coronary artery dissection associated with cocaine use: a case report and brief review. Cardiovasc Pathol. 2001;10:141–5.

    Article  CAS  PubMed  Google Scholar 

  51. Basso C, Corrado D, Thiene G. Congenital coronary artery anomalies as an important cause of sudden death in the young. Cardiol Rev. 2001;9:312–7.

    Article  CAS  PubMed  Google Scholar 

  52. Basso C, Corrado D, Thiene G. Coronary artery anomalies and sudden death. Card Electrophysiol Rev. 2002;6:107–11.

    Article  PubMed  Google Scholar 

  53. Basso C, Frescura C, Corrado D, Muriago M, Angelini A, Daliento L, Thiene G. Congenital heart disease and sudden death in the young. Hum Pathol. 1995;26:1065–72.

    Article  CAS  PubMed  Google Scholar 

  54. Frescura C, Basso C, Thiene G, Corrado D, Pennelli T, Angelini A, Daliento L. Anomalous origin of coronary arteries and risk of sudden death: a study based on an autopsy population of congenital heart disease. Hum Pathol. 1998;29:689–95.

    Article  CAS  PubMed  Google Scholar 

  55. Roberts WC. Major anomalies of coronary arterial origin seen in adulthood. Am Heart J. 1986;111:941–63.

    Article  CAS  PubMed  Google Scholar 

  56. Taylor AJ, Rogan KM, Virmani R. Sudden cardiac death associated with isolated congenital coronary artery anomalies. J Am Coll Cardiol. 1992;20:640–7.

    Article  CAS  PubMed  Google Scholar 

  57. Angelini P. Coronary artery anomalies: an entity in search of an identity. Circulation. 2007;115:1296–305.

    PubMed  Google Scholar 

  58. Bland E, White P, Garland J. Congenital anomalies of the coronary arteries. Am Heart J. 1933;8:797–801.

    Article  Google Scholar 

  59. Yau JM, Singh R, Halpern EJ, Fischman D. Anomalous origin of the left coronary artery from the pulmonary artery in adults: a comprehensive review of 151 adult cases and a new diagnosis in a 53-year-old woman. Clin Cardiol. 2011;34:204–10.

    Article  PubMed  Google Scholar 

  60. Krexi L, Sheppard MN. Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA), a forgotten congenital cause of sudden death in the adult. Cardiovasc Pathol. 2013;22:294–7.

    Article  PubMed  Google Scholar 

  61. Basso C, Burke M, Fornes P, Gallagher PJ, de Gouveia RH, Sheppard M, Thiene G, van der Wal A. Guidelines for autopsy investigation of sudden cardiac death. Virchows Arch. 2008;452:11–8.

    Article  PubMed  Google Scholar 

  62. Basso C, Maron BJ, Corrado D, Thiene G. Clinical profile of congenital coronary artery anomalies with origin from the wrong aortic sinus leading to sudden death in young competitive athletes. J Am Coll Cardiol. 2000;35:1493–501.

    Article  CAS  PubMed  Google Scholar 

  63. Cheitlin MD, De Castro CM, McAllister HA. Sudden death as a complication of anomalous left coronary origin from the anterior sinus of Valsalva. A not-so-minor congenital anomaly. Circulation. 1974;50:780–7.

    Article  CAS  PubMed  Google Scholar 

  64. Liberthson RR, Dinsmore RE, Fallon JT. Aberrant coronary artery origin from the aorta: report of 18 patients, review of the literature and delineation of natural history and management. Circulation. 1979;59:748–54.

    Article  CAS  PubMed  Google Scholar 

  65. Lim JC, Beale A, Ramcharitar S. Anomalous origination of a coronary artery from the opposite sinus. Nat Rev Cardiol. 2011;8:706–19.

    Article  PubMed  Google Scholar 

  66. Cohle SD. Circumflex artery from the right coronary sinus: a not-so-benign anomaly. Am J Forensic Med Pathol. 2012;33:107–9.

    Article  PubMed  Google Scholar 

  67. Corrado D, Pennelli T, Piovesana PG, Thiene G. Anomalous origin of the left circumflex coronary artery from the right aortic sinus of Valsalva and sudden death. Cardiovasc Pathol. 1994;3:269–71.

    Article  CAS  PubMed  Google Scholar 

  68. Muriago M, Sheppard MN, Ho SY, Anderson RH. Location of the coronary arterial orifices in the normal heart. Clin Anat. 1997;10:297–302.

    Google Scholar 

  69. Corban MT, Hung OY, Eshtehardi P, Rasoul-Arzrumly E, McDaniel M, Mekonnen G, Timmins LH, Lutz J, Guyton RA, Samady H. Myocardial bridging: contemporary understanding of pathophysiology with implications for diagnostic and therapeutic strategies. J Am Coll Cardiol. 2014;63:2346–55.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Ferreira AG, Trotter SE, Konig B, Ferreira AG, Trotter SE, Konig B. Myocardial bridges: morphological and functional aspects. Br Heart J. 1991;66:364–7.

    Article  PubMed  PubMed Central  Google Scholar 

  71. Morales AR, Romanelli R, Boucek RJ. The mural left anterior descending coronary artery, strenuous exercise and sudden death. Circulation. 1980;62:230–7.

    Article  CAS  PubMed  Google Scholar 

  72. Gori F, Basso C, Thiene G. Myocardial infarction in a patient with hypertrophic cardiomyopathy. N Engl J Med. 2000;342:593–4.

    Article  CAS  PubMed  Google Scholar 

  73. Basso C, Thiene G, Mackey-Bojack S, Frigo AC, Corrado D, Maron BJ. Myocardial bridging, a frequent component of the hypertrophic cardiomyopathy phenotype, lacks systematic association with sudden cardiac death. Eur Heart J. 2009;30:1627–34.

    Article  PubMed  Google Scholar 

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Thiene, G., Corrado, D., Basso, C. (2016). Coronary Artery Disease. In: Sudden Cardiac Death in the Young and Athletes. Springer, Milano. https://doi.org/10.1007/978-88-470-5776-0_3

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