The Spectrum of Intramyocardial Small Vessel Disease Associated with Sudden Death

Veinot, John P.; Johnston, Brian; Acharya, Virbala; Healey, Jeff S.

doi:10.1520/jfs15263j

Cited by 24 publications

(11 citation statements)

References 11 publications

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“…This constant ratio of group 3 arteries between these two age groups strengthens the conclusion that the incidence of FMD in (Nerantzis et al 2003)]. Due to the narrowness of their lumen, FMD in small arteries can lead to inadequate perfusion, poor collateral blood flow, fibrosis, PM dysfunction or even rupture, sensitivity to arrhythmias and premature death (James 1990;Burke and Virmani 1998;Michaud et al 2001;Veinot et al 2007). There is thus a strong relationship between the presence of small vessel disease and the occurrence of PM fibrosis.…”

Section: Discussionsupporting

confidence: 63%

Age-related fibromuscular dysplasia in the human left ventricle papillary muscles arteries

Nerantzis¹,

Karakoukis²,

Lernia³

et al. 2016

Anat Sci Int

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We describe histologically cases of patients between 31 and 60 years of age who had fibromuscular dysplasia (FMD) in the tunica media (TM) of the left ventricle papillary muscles (PM) arteries. We also compared them with our previous findings in subjects younger than 30 years of age. We examined histologically samples taken from the tip of the anterior PM of the left ventricle in 200 healthy male hearts. In 33 cases (16.5 %), FMD was in the TM. We divided these cases into three subgroups (A, B, C) based on the degree of replacement of smooth muscle cells by fibrous tissue, and thus identified 17, 11 and 5 cases, respectively. Until the age of 41, the typical lesions were often localized within the TM. Beyond that age, the fibrous tissue increased in the TM wall and in the surrounding area of the vessels, causing dysfunction of the PM. Degenerative lesions, as well as inflammatory infiltration, were found after the age of 53. The findings of this study will be useful to cardiologists and cardiac surgeons, in pointing out that, after the age of 44 years old, some PM and their supporting valves may present a degree of dysfunction.

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Section: Discussionsupporting

confidence: 63%

Age-related fibromuscular dysplasia in the human left ventricle papillary muscles arteries

Nerantzis¹,

Karakoukis²,

Lernia³

et al. 2016

Anat Sci Int

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“…Small vessel disease has been reported as an isolated cardiac anomaly in individuals with sudden death and may also be associated with other cardiac conditions. 11 In conclusion, in all cases, the probable mechanism of sudden death was ventricular arrhythmia due to myocardial ischaemia secondary to non-atherosclerotic coronary disease.…”

Section: Discussionmentioning

confidence: 79%

Non-atherosclerotic coronary pathology causing sudden death

et al. 2007

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Coronary atherosclerosis is responsible for .50% of all cases of sudden death and for 90% of sudden coronary death. Four cases encountered in routine autopsy evaluation at our institute in 2004 in which non-atherosclerotic coronary pathology was responsible for sudden cardiac death are reported. The cases of a 31-year-old man with epicardial coronary arteritis, a 57-year-old man with intramyocardial vasculitis, a 45-year-old woman with spontaneous coronary dissection and a 50-yearold man with vascular fibrosis are described. Searching for non-atherosclerotic coronary disease is relevant for both the clinician and the pathologist to prevent coronary causes of sudden death going unrecognised. N on-atherosclerotic coronary artery disease is a condition often unrecognised in the living and in the dead. In a survey of 278 cases of sudden death in Italy, 28 cases were due to non-atherosclerotic coronary artery disease. 1 Similar rates have been reported elsewhere.2 In living patients with acute myocardial ischaemia, non-atherosclerotic coronary disease is occasionally recognised but only when the lesions are seen in coronary angiography as congenital abnormalities or lesions causing coronary lumen stenoses or aneurysms. We report four cases encountered in routine autopsy evaluation at our institute in 2004 in which non-atherosclerotic coronary disease was responsible for sudden cardiac death. Box 1 lists the most common causes of sudden cardiac death.Case 1: epicardial coronary arteritis A 31-year-old man brought to hospital by the emergency medical services (EMS) was pronounced dead on arrival. Death had occurred suddenly, with no anticipatory symptoms of chest pain or discomfort. Medical history was non-contributory.The gross pathological examination was mostly unremarkable, except for a mildly discoloured region of the anterolateral myocardium. Histological examination showed signs of recent ischaemic damage. Examination of the left descending anterior artery showed no evidence of intraluminal thrombus or lumen stenosis. Serial sections of the artery were taken for histological examination. Light microscopical examination after standard haematoxylin-eosin staining showed the presence of a circumferential transmural inflammatory cell infiltrate extending from the adventitia to the intima and composed predominantly of CD8+ T lymphocytes (fig 1). The remaining coronary arteries and the other (non-coronary) arteries were disease free.In face of the early ischaemic changes-variable waviness of fibres-but no evident necrosis, the cause of death was deemed arrhythmic death secondary to myocardial ischaemia caused by non-atherosclerotic non-thrombotic coronary disease. Case 2: intramyocardial vasculitisA 57-year-old man was found in cardiac arrest by the EMS and pronounced dead at the scene. Death had occurred unexpectedly.Medical history was unremarkable. Findings of the gross pathological examination were unremarkable. The left and right ventricles had a normal appearance at gross examination. The coronary arteries were ...

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“…85,89 In the forensic pathology literature, there are reported cases of histopathological findings consistent with FMD identified on postmortem examination among individuals with sudden cardiac death. [90][91][92][93] In these cases, the sinoatrial and atrioventricular nodal arteries were most commonly involved. Similarly, there are case reports of histopathological findings consistent with FMD of the coronary arteries among victims of sudden infant death syndrome.…”

Section: Fmd Of the Coronary Arteriesmentioning

confidence: 96%