The death rate due to cardiovascular disease increased each decade in the United States until the
Since then, there has been a dramatic decline in the death rates from myocardial ischemia and its
Although the reasons for this are not well understood, they are likely due, in part, to
improved detection and treatment of hypertension, a toward a more prudent diet, and improvements in the
medical and surgical care for cardiovascular disease.
There is a general overall increase in heath
awareness in our society, more emphasis on disease prevention, and a growing interest in exercise, or
Despite these advances, the problem of premature death due to cardiovascular disease is
formidable - more Americans die of cardiovascular disease than from any other cause (Table 1).
there were an estimated 2,047,000 deaths in the United States.
Just under half (48%) of these were
cardiovascular disease deaths, two-thirds of which were caused by underlying coronary and ischemic
Estimated Leading Causes of Death in the United States, 1985.
Diseases of the heart and blood vessels
Chronic obstructive pulmonary disease
Pneumonia and influenza
All other causes
Source: National Center for Health Statistics, U.S. Public Health Service, DHHS
For patients with acute myocardial infarction who reach the hospital, mortality from coronary disease
has also substantially declined.
This is due, in part, to the immediate resuscitation efforts possible in
coronary care areas of hospitals and a reduction in the incidence of ventricular fibrillation by early
antiarrhythmic drug therapy.
The recent results of trials employing thrombolytic therapy and/or
percutaneous transluminal angioplasty hold promise for further reducing mortality from acute ischemic
There are two major clinical syndromes that result in death from ischemic heart disease that occur
sudden arrhythmic death due to cardiac arrest
death due to myocardial failure
Although sudden arrhythmic death occurs most often in patients with previously recognized ischemic
heart disease, unexpected cardiac arrest is the first manifestation of underlying heart disease in up to 20%
The majority of patients who suffer sudden death have no premonitory symptom-initiated but