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Sudden cardiac death is thought to be a major public health problem. There are marked regional differences in the frequency of out-of-hospital cardiac deaths and a high proportion of deaths occur in middle-aged men. We have observed in a prospective study of sudden unexplained death a clustering of events in two distinct periods, some of which have functional correlates. The first period, with two peaks at 30 and 70 days after the event, corresponds to a period of increased sympathetic nerve activity, sinus tachycardia and a fall in resting heart rate. The second period is marked by a slow rise in sympathetic activity, occurring after 2 weeks of an event, and a decrease in heart rate and peak systolic blood pressure. Of the 119 cases, 57 (48%) had no obvious structural lesions as determined by postmortem examinations and 58 (48%) had structural abnormalities. The location of the infarcts was right ventricular (36), left ventricular (22), left main coronary artery (4) and right coronary artery (8). An electrocardiograph obtained in the first week after the event was available in 83 cases.Cytokine production by isolated rat intestinal macrophages stimulated with hydrocortisone and corticosterone in vitro.

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