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Left ventricular subendocardial haemorrhages. A study of their morphology, pathogenesis and prognosis
Insights
Subendocardial hemorrhages, linked to hypoxia from various conditions, indicate potential silent progression to chronic ischemic cardiomyopathy. These lesions, seen in autopsy cases, highlight cardiovascular injury risks.
Area of Science:
- Pathology
- Cardiovascular Medicine
- Forensic Medicine
Background:
- Subendocardial hemorrhages are observed in diverse clinical scenarios.
- These hemorrhages are often associated with conditions causing sudden general hypoxia.
Purpose of the Study:
- To investigate the causes, timing, and pathological features of subendocardial hemorrhages.
- To correlate morphological alterations with time intervals and determine causes of death.
Main Methods:
- Retrospective analysis of 181 medicolegal and clinicopathological autopsy cases.
- Examination of gross and microscopic cardiac findings, focusing on the subendocardium.
Main Results:
- Subendocardial hemorrhages were associated with trauma, poisoning, epilepsy, shock, and intracranial diseases.
- Lesions included myocytic necrosis, inflammation, and vascular damage, predominantly in subendocardial regions and papillary muscle apices.
- Cardiovascular disturbances caused death in 15% of cases; others had transient or absent clinical signs despite widespread lesions.
Conclusions:
- Subendocardial hemorrhages result from general hypoxic cardiovascular injury.
- Morphological changes correlate with the time since the primary condition's onset.
- Clinically silent or transient hypoxic lesions may progress to chronic ischemic cardiomyopathy.
Abstract:
181 medicolegal and clinicopathological autopsy cases with subendocardial haemorrhages were studied with special reference to the primary conditions which might have triggered the haemorrhages, the time interval between the onset of these conditions and death, the gross and microscopic appearances of the subendocardium and other parts of the heart and the cause of death. There was a wide panorama of conditions associated with subendocardial haemorrhages: Trauma, poisoning, eilepsy, surgical and obstetric shock, intracranial diseases and others with the same sudden onset of a process which caused general hypoxia. Death occurred immediately or up to 24 days after the trauma or onset of the primary condition. The subendocardial haemorrhages were associated with myocytic necrosis, inflammatory reaction and vascular lesions in the entire myocardium. The subendocardial regions and the apexes of the papillar muscles were the most common sites of manifestations of the general hypoxic cardiovascular injury. The morphological alterations correlated well with the time lapse after the onset of the associated condition. In 27 cases, or 15 per cent, death was attributed to cardiovascular disturbances, presumably caused by the lesions described. In the rest of the cases, cardiovascular disturbances were not clinically registered due to the short time of survival, or were transient or absent, despite the presence of widely spread cardiovascular lesions. It is suggested that in cases with clinically transient or asymptomatic recent hypoxic cardiovascular lesions there is a possibility for a silent progression of the pathological process in chronic ischemic cardiomyopathy.