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[Myocardial pathology in sudden ischemic death: peculiarities of morphologic diagnosis]
Elena Stalioraityte1, Dalia Pangonyte, Juozas Bluzas
1Institute of Cardiology, Kaunas University of Medicine, Kaunas, Lithuania.
Insights
Sudden ischemic death is linked to irreversible myocardial injury, often acute myocardial infarction. Early identification requires microscopic analysis of the whole myocardium and coronary arteries.
Area of Science:
- Cardiovascular Pathology
- Forensic Medicine
- Pathology
Background:
- Sudden out-of-hospital death from ischemic heart disease is a significant public health concern.
- Understanding the morphological basis of these events is crucial for accurate diagnosis and prevention strategies.
Purpose of the Study:
- To establish morphological criteria for identifying acute myocardial injuries in cases of sudden ischemic death.
- To correlate these findings with the phases of myocardial infarction.
Main Methods:
- Morphological examination of the entire myocardium and coronary arteries in 170 victims of sudden out-of-hospital death.
- Utilized data from the international WHO "Myocardial Infarction Register in Population" and a joint USSR-USA project.
Main Results:
- Sudden ischemic death was consistently associated with irreversible myocardial injury (92.9% acute myocardial infarction, 7.1% micronecrosis).
- Phases of infarction identified: early (48.8%), definite (21.8%), and progressing (22.3%).
- Early infarction signs were present in 34 progressing cases, suggesting a link to sudden death in 71.1% of patients.
Conclusions:
- Accurate diagnosis of early myocardial infarction necessitates microscopic examination of myocardial histotopograms, assessing cardiomyocyte alteration and inflammatory response.
- Acute coronary artery pathology, such as plaque erosion or rupture, indicates regional myocardial injury.
Objective:
The aim of the investigation was to determine morphological criteria of acute myocardial injures in sudden ischemic death.
Material And Methods:
Morphological investigation of the whole myocardium and coronary arteries in 170 victims of sudden out-of-hospital death due to ischemic heart disease was performed in the framework of the international WHO program "Myocardial Infarction Register in Population" and joint (at that time) USSR-USA project on sudden death.
Results:
It was established, that out-of-hospital sudden death due to ischemic heart disease in all cases is related to irreversible myocardial injury: 92.9% - to acute myocardial infarction, and 7.1% - to micronecrosis. The following phases of morphological development of infarction were determined: early myocardial infarction--in 48.8, definite--in 21.8, and progressing--in 22.3%. Since the signs of early infarction were also found in 34 cases of progressing myocardial infarction, it was reasonable to suppose that in 117 (71.1%) patients the occurrence of sudden out-of-hospital death due to ischemic heart disease was somehow connected with the very early and early phases of acute myocardial infarction.
Conclusions:
Accurate identification of early myocardial infarction is available only by microscopic investigation of histotopograms of the whole myocardium considering the complex of signs of cardiomyocyte alteration as well as early inflammatory reaction. Acute pathology (erosion or rupture of atherosclerotic plaque and thrombosis) of "culprit" coronary artery indirectly indicates regional myocardial irreversible injury.
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