A study of 59 persons dying of coronary artery disease revealed that persons dying instantaneously differed from persons dying suddenly of coronary artery disease in that (1) they rarely experienced acute symptoms or exhibited acute signs before death; (2) more than one half died during or immediately after physical exertion; (3) their deaths appeared to result from a primary arrhythmia; and (4) their hearts rarely showed an acute lesion of any kind and frequently exhibited two old occluded coronary arteries or one old occluded, left anterior descending artery. These latter differences should permit angiographic detection of many persons prone to instantaneous death.
Friedman M, Manwaring JH, Rosenman RH, Donlon G, Ortega P, Grube SM. Instantaneous and Sudden DeathsClinical and Pathological Differentiation in Coronary Artery Disease. JAMA. 1973;225(11):1319–1328. doi:10.1001/jama.1973.03220390021005
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