Panarteritis precipitating extensive circumferential acute myocardial infarction. A case report

Area of Science:

• Cardiovascular Pathology
• Immunopathology

Background:

• Acute myocardial infarction (AMI) is often linked to coronary thrombosis.
• However, other precipitating factors can cause AMI in patients with coronary atherosclerosis.

Observation:

• A 48-year-old male presented with acute coronary insufficiency, diagnosed with anterolateral necrosis and lateral ischemia via ECG.
• Despite medical management, angina persisted, leading to death post-coronary angiography.
• Autopsy revealed extensive myocardial necrosis and severe atherosclerotic coronary lesions.

Findings:

• Autopsy demonstrated established coagulation necrosis in the lateral and posterior left ventricular walls and early necrosis in anterior, posterior, and septal walls.
• Severe atherosclerosis affected all major coronary arteries.
• Extensive panarteritis involving coronary artery branches, characterized by mononuclear cell infiltration and edema, was identified.

Implications:

• The findings suggest a mixed mechanism for myocardial necrosis, involving panarteritis, edema, and potentially humoral-induced coronary spasm.
• This case underscores the importance of considering inflammatory and non-thrombotic causes of AMI in complex cases.
• Further research into the role of panarteritis in acute coronary syndromes is warranted.