Stress-Related Sudden Death-Reply

—Dr Rosch is right in pointing out the relationship of increased secretion of stress-related catecholamines and sudden death. We certainly agree that attention should be directed to efforts that further our knowledge of the pathophysiology of stress-related sudden death, which may lead to preventive measures.

However, we should keep in mind that pathologic findings in the conduction system were present in all cases of sudden death that were examined by us by serial-section methods. There were several types of pathologic lesions (congenital, acquired, or both) found in a single case both in the myocardium and in the specialized conduction system. Whether these findings are the result of recurrent arrhythmias or the drugs given in some of the cases is beyond the scope of this discussion. It is difficult for us at the present time to minimize these findings in cases of sudden death, because some of the patients studied