Mechanisms of DeathDeath is almost certainly due to myocardial ischemia, but the exact mechanism is unknown. The left ventricularmyocardium has a huge demand for oxygen during strenuous exercise. Systolic pressure increases during strenuousexercise, and there is activation of the sympathetic nervous system. The root of the aorta therefore distends insystole. If part of the anomalous artery runs within the wall, it may be compressed, and if the artery runs adjacentto the wall, it may be stretched, compressed, or both. Presumably, the severe myocardial ischemia
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