[Sudden cardiac death].
Sudden cardiac death, most often due to ventricular fibrillation, is caused by three vessel coronary disease in over 90% of the cases. At autopsy acute coronary thrombosis superimposed on an arteriosclerotic plaque is often found. However, a terminal myocardial ischemia can also develop without coronary thrombosis. In these cases platelet thrombi or coronary spasm may be the cause of ventricular fibrillation. In approximately one fourth of all patients with coronary disease sudden death is the first manifestation of the patient's illness. After myocardial infarction a high risk patient group can be detected by non-invasive methods: patients with cardiac failure, high enzyme values, a positive exercise-ECG and malignant ventricular arrhythmias three weeks after myocardial infarction have a significantly higher mortality in the following 12 months than patients without these complications. In this group of patients prevention of sudden death should be tried by an aggressive management of myocardial ischemia, heart failure and ventricular arrhythmias.