In recent months there have been several articles published dealing with various phases of the terminal cardiac mechanism in patients suffering from disease of the coronary arteries. The presumption is that sudden, unexpected death both of patients with angina pectoris and of those with coronary occlusion is generally due to fibrillation of the ventricles. There is evidence, however, that in at least some such cases the terminal cardiac mechanism is ventricular standstill due to overwhelming, sudden stimulation of the vagus resulting in paralysis of the pacemaker. There have been but very few electrocardiograms recorded at the time of sudden death of patients with these conditions. Therefore but little direct evidence is available as to the exact terminal cardiac mechanism.
In a review of the literature on this subject in 1939, Smith1 found 4 published instances of electrocardiograms showing ventricular fibrillations causing sudden, unexpected death. To the list he added
Thompson I. VENTRICULAR FIBRILLATION CAUSING SUDDEN DEATH OF A PATIENT WITH DISEASE OF THE LEFT CORONARY ARTERY. JAMA. 1941;116(23):2583–2585. doi:10.1001/jama.1941.62820230001009
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