The risk factors for arrhythmic death in a sample of men followed for 20 years.

In a sample of 301 men, aged 54-62 years, who were employed in the telephone industry in New Jersey, and who were followed prospectively from 1963/1964 to 1984, 65 of 148 deaths were manifested by the abrupt occurrence of fatal ventricular arrhythmias. On multivariate analysis, the factors present at the initial examination that were significantly related to the subsequent occurrence of arrhythmic deaths were: abnormal patterns of QRS conduction; the level of blood pressure; the number of cigarettes currently being smoked; chronic myocardial ischemia; chronic airway disease; and failure to engage in any exercise or heavy physical activity. Among 28 other potential risk factors representing myocardial disorders, ventricular dysrhythmias, other disorders of cardiac rate, rhythm, conduction, and repolarization, and non-cardiac risk factors (including cholesterol level, serum uric acid level, diabetes mellitus, alcohol intake, general arteriosclerosis, other non-cardiac disease, and social, behavioral, and attitudinal variables), none significantly added to risk for arrhythmic death. The risk factors related to the subsequent occurrence of other deaths, manifested by the gradual development of circulatory failure, were significantly different from the risk factors related to arrhythmic deaths.

Stress and disease: the concept after 50 years.

Although there is no generally accepted definition of 'a state of stress' in biological or social systems, biologists and social and behavioral scientists continue to use the term. They communicate meaningfully by describing and measuring sources of stress and their observed effects on living organisms, without attempting to define the intervening variables. Biologists and medical scientists tend to be concerned with sources of stress that are concrete and observable, and can otherwise be considered as 'causes' of illness and injury; social and behavioral sciences tend to be concerned with sources of stress that represent information that arises from outside the person and is mediated by higher centers of the central nervous system. It is clear that such "psychological stresses" can lead to alterations of internal functions down to the biochemical level, and that they are potential 'causes' of disease; but they do not usually act independently of other mechanisms. The central thesis of the stress theory of disease, as elaborated by Cannon and Selye, appears to have been thoroughly established. Disease can be regarded as a phenomenon that occurs when an agent or condition threatens to destroy the dynamic steady state upon which the integrity of the organism depends; and the manifestations of disease appear to be, in large measure, manifestations of the organism's efforts to adapt to, and to contain, threats to its integrity. In this sense, all diseases are to some extent disorders of adaptation.(ABSTRACT TRUNCATED AT 250 WORDS)

Clinical classification of cardiac deaths.

One hundred forty-two deaths among 743 men ages 50 - 65 years who had been examined and followed 5 - 10 years were investigated and classified on the basis of clinical information from medical and non-medical observers, ECGs and autopsies. A classification based on the condition of the circulation immediately before death appears to be most relevant to studies of sudden death. In 58% of the cases, the subjects collapsed abruptly and his pulse ceased without prior circulatory collapse (arrhythmic death); in 42%, the pulse ceased only after the peripheral circulation had collapsed (deaths in circulatory failure). Thirty-three percent of arrhythmic deaths and 10% of deaths in circulatory failure occurred in a setting of clinical evidence of acute ischemic heart disease (p less than 0.005). Forty-five percent of arrhythmic deaths were preceded by chronic congestive heart failure without circulatory collapse. Ninety-three percent of final illnesses that lasted less than 1 hour ended in arrhythmic deaths; 74% lasted more than 1 day ended in deaths in circulatory failure (p less than 0.001). Eighty-eight percent of deaths that occurred outside of the hospital were arrhythmic; 71% of deaths that occurred in the hospital were deaths in circulatory failure (p less than 0.001). Ninety percent of deaths in which the primary cause of the final illness was heart disease were arrhythmic; 86% of deaths in which the primary cause was other than heart disease were deaths in circulatory failure (p less than 0.001). Ninety-one percent of deaths precipitated by an acute cardiac event were arrhythmic; 98% precipitated by acute respiratory obstruction, hemorrhage, infection, stroke or other noncardiac events were deaths in circulatory failure (p less than 0.001).

Pathogenesis of an unexpected sudden death: role of early cycle ventricular premature contractions.

A 61 year old man who had been studied extensively died unexpectedly ("instantaneously") outside the hospital while wearing an electrocardiographic recorder. Death was caused by ventricular fibrillation, which was initiated by an early cycle ventricular premature contraction occurring in the vulnerable period of repolarization. Such early cycle ventricular premature contraction had been noted in recordings 4 years previously but had never been observed to encroach on the T wave until 5 minutes before death. In the intervening period, the patient had shown increasing evidence of myocardial ischemia and hypertrophy and congestive heart failure, which had been partly obscured by his concealment or denial of symptoms and refusal to change his pattern of activities. Autopsy revealed two old myocardial infarcts and pronounced left ventricular hypertrophy. There was advanced occlusive arteriosclerosis of the major coronary vessels with a recent thrombus in the right coronary artery.