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Disseminated intravascular coagulation in the aged complicated by acute myocardial infarction
Insights
Disseminated intravascular coagulation (DIC) frequently causes cardiac issues in elderly patients, including coronary thrombosis and myocardial necrosis. Recognizing these cardiac complications is vital for timely intervention and improved patient outcomes.
Area of Science:
- Cardiology
- Pathology
- Geriatrics
Background:
- Disseminated intravascular coagulation (DIC) is a complex syndrome with significant systemic implications.
- Cardiac involvement in elderly patients with DIC is often underrecognized.
- Autopsy studies are crucial for understanding the pathologic features of DIC-related cardiac lesions.
Purpose of the Study:
- To investigate the incidence and pathologic characteristics of cardiac lesions in aged patients with DIC.
- To correlate cardiac findings with clinical presentation and electrocardiographic changes.
- To highlight the importance of cardiac involvement in DIC mortality.
Main Methods:
- Retrospective analysis of autopsy findings in 184 elderly patients diagnosed with DIC.
- Detailed examination of cardiac structures for evidence of thrombosis, necrosis, and hemorrhage.
- Review of clinical records, including symptoms and electrocardiographic data.
Main Results:
- Cardiac lesions were prevalent, with coronary thrombosis (16.8%), myocardial necrosis (32.6%), and hemorrhage (26.6%) being common.
- Acute myocardial infarction occurred in 8.7% of patients, frequently associated with coronary thrombosis.
- Clinical symptoms and ECG findings were often atypical or non-diagnostic for myocardial infarction in this cohort.
Conclusions:
- Coronary thrombi in DIC may progress, leading to extensive myocardial necrosis.
- Cardiac complications like heart failure, arrhythmia, and rupture contribute to mortality in elderly DIC patients.
- Early recognition of cardiac involvement in aged patients with DIC is critical for management.
Abstract:
The incidence and pathologic features of cardiac lesions in 184 autopsied aged patients with disseminated intravascular coagulation (DIC) were reported. Coronary thrombosis was noted in 31 (16.8%), fresh myocardial necrosis in 60 (32.6%) and massive myocardial hemorrhage in 49 (26.6%) of these patients. Fresh myocardial infarction was present in 16 (8.7%) patients, 13 of whom manifested coronary thrombosis. The site of thrombi deposition was closely related to preexisting stenotic lesions of the coronary arteries. Only 3 of 16 patients with disseminated intravascular coagulation and acute myocardial infarction had typical cardiac symptoms. In most patients, the electrocardiographic changes were equivocal or not diagnostic for the diagnosis of acute myocardial infarction. We suggest the possibility that coronary thrombi in disseminated intravascular coagulation may gradually increase in extent and severity, leading to confluent areas of myocardial necrosis. The possibility of death due to heart failure, arrhythmia or cardiac rupture, points to the importance of recognizing the frequent cardiac involvement in aged patients with disseminated intravascular coagulation.