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January 24, 1966

Intramyocardial Lesions in Patients Dying Suddenly and Unexpectedly

Author Affiliations

From the Laboratory Service (Dr. H. L. Richardson) and Department of Medicine (Dr. Graupner), Veterans Administration Hospital, North Little Rock, Ark, and the Department of Pathology, University of Arkansas Medical Center, Little Rock (Dr. M. E. Richardson).

JAMA. 1966;195(4):254-260. doi:10.1001/jama.1966.03100040060017

In a 2,000-bed neuropsychiatric hospital, one to two cases of sudden, unexpected death occur per year in patients in whom the postmortem examination reveals no obvious cause of death. Serial electrocardiograms revealed some disorder of electrical activity rhythm and conduction. Between the years 1957 to 1962, small heart sections did not adequately explain abnormal ECGs. Four patients receiving tranquilizers who died suddenly and unexpectedly during 1964 and 1965 were studied. The hearts of 49 nontranquilized patients were compared. Histochemical techniques were used. Lesions were in the intramyocardial arterioles (40μ -80μ ) and the arteriolarcapillary bed (14μ-40μ). Acid mucopolysaccharide was in and about these altered arterioles and degenerating myocardial muscle. The lesions were subendocardial in the right and left atrioventricular conduction bundle and papillary muscles.