[Non arrhythmogenic sudden death as complication of coronary heart disease].

In a cohort of 417 patients admitted consecutively to the Coronary Care Unit for acute myocardial ischemia (unstable angina pectoris in 121, acute myocardial infarction in 296 patients) 21 cases of non arrhythmogenic sudden death occurred within 24 hours after admission. 16 of these patients suffered from acute myocardial infarction and 5 from unstable angina pectoris. Cause of death was cardiac rupture in 12 and pump failure in 4 patients with acute myocardial infarction, whereas all patients with unstable angina pectoris died from pump failure. Patients with cardiac rupture within 24 hours after admission, had significantly higher systolic and diastolic blood pressure in comparison with the other groups and with patients dying from cardiac rupture on the third day, or later. All patients dying from pump failure with unstable angina pectoris and one of the patients dying from pump failure with acute myocardial infarction had beta blocker therapy. Beta blockers were given to 68 of the patients with unstable angina pectoris. Acute pump failure occurred in this group only. The risk of pump failure with beta receptor blocking drugs is indicated by angina decubitus, marked dyspnea during anginal attacks (even in patients free of signs of cardial insufficiency outside their attacks) and a lack of responsiveness to beta blocking therapy. In these patients rapid coronary angiography and bypass surgery seems to be the prefered method of management. Beta blockers should not be given to these patients or discontinued in cases which lack responsiveness.