Besides being the leading cause of death nationwide, atherosclerotic heart disease is also the leading cause of sudden unexpected natural death. Atherosclerosis ("hardening" of the arteries) refers to the fat and other deposits which build up on the inside lining of blood vessels. This can lead to a plugging of the vessel, preventing blood and oxygen from getting to the tissues. Atherosclerosis primarily affects the larger elastic arteries, such as the aorta, carotids, and iliacs, as well as smaller muscular arteries, such as the coronary arteries in the heart.
Atherosclerotic coronary artery disease is the most common cause of death due to heart disease. Proper oxygenation of the heart wall (myocardium) is prevented because of the plugging of the vessel. When severe, this buildup leads to chest pain, heart attacks, and arrhythmias (abnormal heart beats). Arrhythmias are the main complication of atherosclerotic coronary artery disease, causing sudden death. They cannot be detected by either gross or microscopic examination of the heart at autopsy because they are an electrical activity. Since it cannot be seen, an arrhythmia must be determined as the final event causing death by excluding all other possibilities. However, the atherosclerotic disease in the blood vessels is usually present at autopsy. Signs of heart attacks may or may not be evident. People die with varying amounts of disease and the amount of obstruction needed to cause death will vary between individuals and circumstances. A man with known severe triple vessel coronary artery disease may live for many years while one with only moderate single vessel disease may die suddenly without having any previous signs or symptoms.
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