PERACUTE AND ACUTE DEATH FROM ISCHEMIC HEART-DISEASE WITHIN 4 DAYS OF ONSET OF SYMPTOMS

Post-mortem examination was made of 136 patients who died of ischaemic heart disease from within a few minutes to 4 days after the onset of symptoms. Acute myocardial infarction was detected by means of the histochemistry of dehydrogenases in 102 cases (75%); in 34 cases (25%) no infarction was found, but the presence of coronary obstruction together with clinical symptoms justified the diagnosis of acute coronary insufficiency. Fifty-six of the infarctions occurred within 2-3 h after the onset of ischaemia, 24 within 4-5 h, 12 within 6-24 h, and 10 within 1-4 days. The chances of recovery increased if the patients survived for 24 h. The period of 5 h after the onset of ischaemia appeared especially important; 80 of 102 patients with acute myocardial infarction died during that period. Thirty-one of 34 patients with acute coronary insufficiency and 60 of 102 patients with acute myocardial infarction died peracutely, i.e. within a few minutes to 2 h after the onset of symptoms. In the patients of the latter group the onset of symptoms must have been delayed, otherwise none of these patients could have appeared in the category of peracute death. This delay was more obvious in the patients with acute myocardial infarction localized in the area supplied by the left descending artery. The occurrence of peracute deaths could not be correlated with a particular localization of area of infarction. The causes of coronary obstructions and the role of dynamic disturbances of coronary perfusion in the pathogenesis of coronary insufficiency and myocardial infarction are discussed. © 1978.