Sudden Cardiac Death in Patients with Hypertension and Coronary Artery Disease

Definition and Causes

Sudden cardiac death (SCD) is defined as "natural death due to cardiac causes, heralded by abrupt loss of consciousness within one hour of the onset of acute symptoms; preexisting heart disease may have been known to be present, but the time and mode of death are unexpected" according to the European Heart Journal 1, 2
In patients over 65 years with known coronary artery disease (CAD), sudden cardiac death is most commonly attributed to CAD, which accounts for the overwhelming majority of cardiac deaths in this age group, as reported by the European Heart Journal 1, 3
The American Heart Association, as published in Circulation, recommends that for unwitnessed deaths where the patient was seen alive and clinically stable within 24 hours before being found dead, without evidence supporting a specific non-cardiovascular cause, sudden cardiac death should be recorded 4, 5

The immediate cause of death should be listed as Sudden Cardiac Death, as recommended by Circulation 4
The underlying cause of death should be listed as Coronary Artery Disease, as reported by the European Heart Journal 1
The first recorded rhythm in patients presenting with sudden cardiovascular collapse is ventricular fibrillation in 75-80% of cases, which is commonly associated with underlying coronary artery disease, according to the European Heart Journal 1, 6

Autopsy studies indicate that about 2/3 of sudden non-traumatic deaths in middle-aged and elderly subjects are cardiac in origin, with coronary artery disease accounting for the overwhelming majority of these deaths, as reported by the European Heart Journal 2, 3
The European Society of Cardiology, as published in the European Heart Journal, suggests that hypertension should be listed as a contributing factor rather than the underlying cause, as it exacerbates atherosclerosis and contributes to making atherosclerotic plaques more unstable, but is not typically the direct cause of sudden death is not applicable due to [ignore ref], however, the American College of Cardiology recommends avoiding listing "Heart Failure" as the underlying cause of death, as it affects the quality of vital statistics, and instead recommends listing the underlying cause as Coronary Artery Disease 4, 5

The European Society of Cardiology suggests that hematemesis may represent a terminal event related to cardiovascular collapse with aspiration of blood from pulmonary edema or stress-related gastric bleeding during acute cardiac ischemia, or it may have been a coincidental gastrointestinal bleed that precipitated hemodynamic instability in a patient with severe underlying CAD, triggering fatal arrhythmia 7
The interaction of vulnerable substrate, such as genetic predisposition from familial hypercholesterolemia, with acute triggering factors, like possible hemodynamic stress from GI bleeding, can lead to the "perfect storm" of SCD, as noted by the European Heart Journal 7