BACKGROUNDndash; Sudden, unexpected death is a problem of major importance, but very little is known about its cause.REVIEW SUMMARYndash; Of the many sudden death syndromes, in only one (sudden, unexplained death in middle-aged men) has a likely pathogenesis been clarified; namely, functional cardiac arrest due to ventricular arrhythmia. Electrocardiographic abnormalities have been known to occur in the context of neurologic disease for a long time. These changes fall into two categories: arrhythmias and repolarization changes. It is now believed that these changes represent one end of a spectrum of pathologic physiology, which can alter cardiac repolarization, predispose a patient to sudden death, and/or produce a characteristic form of cardiac damage known as myofibrillar degeneration or contraction band necrosis. This lesion can be caused by four classes of etiologies: catecholamine infusion, stress plus or minus steroids, nervous system stimulation, and reperfusion. These four apparently disparate etiologies are tied together by a common thread, the essential feature of which is sympathetic overactivity with secondary catecholamine toxicity.CONCLUSIONSndash; A unifying hypothesis is proposed to explain all the forms of sudden death based on the anatomic connection between the nervous system and the heart and lungs.
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