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Sudden cardiac death associated with premature atheroma in the young: an autopsy study emphasising single-vessel lesions

Published online by Cambridge University Press:  21 July 2015

Anna C. Green Open the ORCID record for Anna C. Green [Opens in a new window]  and
Mary N. Sheppard
Anna C. Green
Affiliation:
Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
Mary N. Sheppard*
Affiliation:
Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, United Kingdom
*
Correspondence to: Professor M. N. Sheppard, CRY Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom. Tel: +44 020 8725 5112; Fax: +44 020 8725 5139; E-mail: m.sheppard@sgul.ac.uk
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Abstract

Aims

This is the first autopsy study in the United Kingdom to analyse the demographic and pathological characteristics of atheroma associated with sudden cardiac death in young people.

Methods

An observational retrospective study of referred cases of sudden cardiac death in the young (⩽35 years) associated with premature atheroma was carried out.

Results

In total, 46 cases were referred, with a median age of 30 years (27, 32); 72% of the referred cases were male, with a mean body mass index of 30 kg/m2. Circumstances of death were as follows: at rest (n=21), exertion (n=7), in bed (n=7), related to drugs/alcohol (n=4), and unknown (n=7). A previous cardiac history was provided in 10 cases. A history of class A/B drug use was found in eight cases. There was macroscopic evidence of infarction in 10 cases (acute, n=3 and chronic, n=7). Microscopically, 10 cases demonstrated contraction band necrosis, 11 acute infarction, and 11 chronic infarction. Single-vessel disease predominated (n=28). The left anterior descending coronary artery was involved in 39/46 cases. Thrombosis was seen in 16 cases, mainly due to erosion; one case showed dual pathology with arrhythmogenic right ventricular cardiomyopathy and another showed left ventricular hypertrophy.

Conclusions

This study highlights premature atheroma mainly in a single vessel in young people with or without evidence of ischaemic damage in the ventricle. Dual pathology may occur. The role of arrhythmias and channelopathies are important considerations. Premature atheroma should prompt investigation for dyslipidaemias in family members.

Keywords

Premature atheromasudden cardiac deathmyocardial infarction
Type
Original Articles
Information
Cardiology in the Young , Volume 26 , Issue 4 , April 2016 , pp. 743 - 748
Copyright
© Cambridge University Press 2015 

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Footnotes

†

Current address: Department of Histopathology, 2nd Floor North Wing, St Thomas Hospital, Westminster Bridge Road, London SE1 7EH, United Kingdom.

‡

Current address: CRY Cardiovascular Pathology, Cardiovascular Sciences Research Centre, St George’s University of London, Cranmer Terrace, London SW17 0RE, United Kingdom.

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