De subitaneis mortibus. XXIX. Randomly distributed focal myocardial lesions causing destruction in the His bundle or a narrow-origin left bundle branch.

Abstract

Most focally destructive lesions of the heart (e.g., myocarditis) have an essentially random distribution. Any mechanical significance of such diseases depends primarily on there being a very large number of foci. However, single even very small lesions can have profound electrophysiological significance if appropriately located within the cardiac conduction system. Two cases of sudden unexpected death are here reported which had destructive lesions involving the His bundle and a narrow-origin left bundle branch. Not much is known of the electrical or mechanical effects of acute left branch block which is due to complete anatomical transection of that structure in the human heart, and some possible consequences (including sudden unexpected death) are considered. Myocarditis or any other focally destructive disease in the heart may be of little functional importance if it is not widespread, unless some of the lesions happen to damage any of several small but crucially important sites in the cardiac conduction system. Studies to determine the presence or absence of this precise type of damage should be done especially in cases of sudden unexpected death.