Brain, heart, and sudden death

During the past 30 years, rate of coronary artery disease, as the main cause of sudden death, has decreased more than rate of sudden death. Likewise, cause of sudden death 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 sudden death. In fact, sudden death 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 sudden death 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 sudden death. Then, we review prototypes of neurological diseases and psychological stressors associated with sudden death and look at heart failure related sudden death providing evidence for the brain-heart connection. Finally, we propose a new look at sudden death risk factors considering both brain and heart in their association with sudden death, and review strategies for prevention of sudden death from this perspective.