In-hospital death from ischaemic heart disease

The clinical course and the clinical and pathological factors were studied in a series of 112 in-hospital patients who died of acute myocardial infarction. A necropsy was performed in 101 cases. 44% of the victims were concluded to have been past the possibility of recovery at the time of admission, as the treatment of early ventricular fibrillation or asystole did not lead to a satisfactory result, or as a refractory heart failure or shock dominated from admission to death. Resuscitations due to early ventricular fibrillation were performed in the emergency department mainly on patients living near the hospital. On the other hand, an early heart failure was more frequent among those whose transit distance was over 15 km. Prior use of beta-receptor blockers seemed to protect against early complications. The cardiac functions of the remaining patients were normal or could be normalized at the beginning of the hospitalization. The great majority of them were later lost as a result of extensive damage of the myocardium leading to a refractory heart failure and some due to a rupture caused by infarction (8%) or due to embolic complications (10%). Only 11 patients (10%) succumbed to late ventricular fibrillation without heart failure, rupture, or embolism. The cardiac disease revealed by the necropsy was more severe in patients with a refractory heart failure than in those who died of late ventricular fibrillation or rupture without a preceding heart failure. Various arrhythmias were frequent during the hospitalization. 74% of the dysrhythmias were preceded or followed by symptoms of a heart failure.