Denier S, Baur H R
Schweiz Med Wochenschr. 1985 Apr 13;115(15):502-7.
Sudden cardiac death, most often due to ventricular fibrillation, is caused by three vessel coronary disease in over 90% of the cases. At autopsy acute coronary thrombosis superimposed on an arteriosclerotic plaque is often found. However, a terminal myocardial ischemia can also develop without coronary thrombosis. In these cases platelet thrombi or coronary spasm may be the cause of ventricular fibrillation. In approximately one fourth of all patients with coronary disease sudden death is the first manifestation of the patient's illness. After myocardial infarction a high risk patient group can be detected by non-invasive methods: patients with cardiac failure, high enzyme values, a positive exercise-ECG and malignant ventricular arrhythmias three weeks after myocardial infarction have a significantly higher mortality in the following 12 months than patients without these complications. In this group of patients prevention of sudden death should be tried by an aggressive management of myocardial ischemia, heart failure and ventricular arrhythmias.
心脏性猝死大多由心室颤动引起，90%以上的病例是由三支血管病变的冠心病所致。尸检时常常发现动脉粥样硬化斑块上叠加有急性冠状动脉血栓形成。然而，也可在无冠状动脉血栓形成的情况下发生终末期心肌缺血。在这些病例中，血小板血栓或冠状动脉痉挛可能是心室颤动的病因。在所有冠心病患者中，约四分之一的患者猝死是其疾病的首发表现。心肌梗死后，可通过非侵入性方法检测出高危患者群体：心肌梗死后3周出现心力衰竭、酶值升高、运动心电图阳性及恶性室性心律失常的患者，在随后12个月中的死亡率显著高于无这些并发症的患者。对于这组患者，应通过积极治疗心肌缺血、心力衰竭和室性心律失常来尝试预防猝死。
