Brain, heart, and sudden death

Shahram Oveisgharan; Fariborz Ghaffarpasand; Peter Sörös; Mustafa Toma; Nizal Sarrafzadegan; Vladimir Hachinski

doi:10.18502/cjn.v21i1.9361

Shahram Oveisgharan Rush Alzheimer’s Disease Center, Rush University of Medical Sciences, Chicago, IL, USA
Fariborz Ghaffarpasand Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
Peter Sörös School of Medicine and Health Sciences, University of Oldenburg, Oldenburg, Germany
Mustafa Toma Division of Cardiology, St. Paul’s Hospital, Vancouver, BC, Canada
Nizal Sarrafzadegan Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Vladimir Hachinski Robarts Research Institute, Western University, Ontario, London, Canada

DOI: https://doi.org/10.18502/cjn.v21i1.9361

Keywords: Sudden Death; Nervous System Diseases; Psychological Stress; Takotsubo Cardiomyopathy; Heart Failure; Stroke; Epilepsy

Abstract

During the past 30 years, rate of coronary artery disease (CAD), as the main cause of sudden death (SD), has decreased more than rate of SD. Likewise, cause of SD remains elusive in not a trivial portion of its victims. One possible reason is attention to only one organ, the heart, as the cause of SD. In fact, SD literature focuses more on the heart, less on the brain, and seldom on both. A change is required. In this paper, we first review the pathological findings seen in heart autopsies of SD victims after psychological stressors such as physical assault victims without internal injuries. Then, we summarize new studies investigating brain areas, like the insula, whose malfunctions and injuries are related to SD. Next, we review prototypes of neurological diseases and psychological stressors associated with SD and look at heart failure
(HF)-related SD providing evidence for the brain-heart connection. Finally, we propose a new look at SD risk factors considering both brain and heart in their association with SD, and review strategies for prevention of SD from this perspective.