De Subitaneis Mortibus

Abstract

Disseminated intravascular coagulation was the cause of death of a 19-year-old woman with a lifelong history of paroxysmal atrial tachycardia. Her final illness began with a bout of tachycardia during her second trimester of pregnancy and was then characterized by sustained tachycardia with hypotension, oliguria, and renal failure, with a steadily falling hematocrit in the absence of significant bleeding externally. At necropsy there were numerous platelet and fibrin emboli throughout the heart. Small arteries in both the sinus node and in the atrioventricular (A-V) node and His bundle were involved. The sinus node was virtually destroyed by recent infarction. Structural variation in the A-V node and His bundle, probably congenital in nature, provided an anatomic substrate for re-entrant loops which may have been the basis for the paroxysmal atrial tachycardia.