Environmental and psychosocial determinants of sudden death.

The risk factors for sudden coronary heart disease (CHD) death have been well described. Sudden CHD deaths should be classified as those occurring in individuals with and those in individuals without a prior history of clinical heart disease. The extent of coronary artery disease, left ventricular dysfunction, and cardiac arrhythmias are the primary pathophysiologic determinants of ventricular fibrillation and sudden death. Psychosocial factors influence the threshold of response to the numerous physical and social environmental stimuli that can precipitate sudden death. The degree of pathology is probably inversely related to the intensity of the stimuli necessary to precipitate sudden CHD death. In the presence of extensive disease the precipitants of sudden deaths are probably ubiquitous in the environment and unlikely to be prevented. Thus, prevention of the basic cardiac disease is of higher priority.