Premonitory Symptoms and Stress Factors Preceding Sudden Death from Ischaemic Heart Disease

. Premonitory symptoms as well as acute and long-standing stress preceding death were studied in 118 cases of prehospital sudden death, 62% of whom had shown premonitory symptoms. Prodromes were found in 94% of those whose fatal attack lasted longer than 2 hours. Premonitory symptoms seemed often to be unspecific in nature in cases of sudden death compared with those experienced by survivors of acute myocardial infarction. The occurrence of prodromes correlated with normal heart weight but not with the severity of the coronary artery disease or the presence of coronary thrombosis. Heavy smoking and a definite myocardial infarction revealed at autopsy were more frequent in those who had prodromes classifiable as unstable angina than in those with unspecific symptoms or without prodromes. The significance of acute and long-standing stress was most evident in the fatality of subjects with no long history of clinical disease. Although stress factors seemed to modify the course of the attack, a basic factor in the fatality was the coronary artery disease of critical severity. Stress factors did not play a major role in the precipitation of premonitory symptoms. Stress in patients with triple vessel disease in the coronaries was, however, more frequently (88%) conductive to prodromes than in those with double or single vessel disease (50%).