The Ventricular Arrhythmias of Ischemia and Infarction [antikvár]

Preface On the Origin of Ischemic Heart Disease, Ventricular Fibrillation, and Sudden Death From our viewpoint today, it seems remarkable that it took such a long period of time before it was widely recognized in the 1960s that sudden death in patients with coronary artery disease is often caused by ventricular arrhythmias, notably ventricular fibrillation. We say this because it had been known for more than a century that sudden death in humans was associated with coronary artery obstruction and that coronary artery obstruction in experimental animals caused ventricular fibrillation. In the 18th century, Heberden first described the clinical syndrome of angina pectoris as "a sort of undescribable anguish across the breast", syncope, and eventually sudden death, but did not relate this syndrome to abnormalities of the coronary arteries (Snellen 1984). In 1779, both John Hunter, an English surgeon and anatomist, and Edward Jenner, famous for the cow-pox vaccine, almost simultaneously reported for the first time extensive ossification and calcification of the coronary arteries in patients with angina who died suddenly (Snellen 1984). At that timé, Charles Parry also published a book {An Inquiry into the Symptoms and Causes of the Syncope Anginosa Commonly Called Angina Pectoris) in which he described in detail autopsies on patients who suffered from angina with sudden death, some of whom also probably had infarcts: after having examined the more important parts of the heart, without finding any thing by means of which I could account either for his sudden death, or the symptoms preceding it, I was making a transverse section of the heart pretty near to its base, when my knife struck against something so hard and gritty, as to notch it. I well remember looking up to the ceiling, which was old and crumbling, conceiving that some plaister had fallen down. But on further scrutiny the real cause appeared: the coronarles were becoming bony canals" (Parry 1799). After investigating several cases of sudden death, Parry wrote that the coronarles may be so obstructed as to intercept the blood, which should be the proper support of the muscular fibers of the heart". He considered this condition to result in "diminishing the energy of the heart" and added in a footnote: "By the energy of the heart I mean not merely the readiness, but also the degree of irritability or excitability" (Parry 1799). Subsequently, Quain (1850) demonstrated the damage to the heart (infarction) resulting from the coronary ob- vii