Ischaemic heart disease. Pato-anatomic findings revealed by comprehensive autopsy technique.

Pato-anatomic findings in epicardial coronary vessels, myocardium and supraventricular parts of the conducting system were investigated by a comprehensive autopsy-technique (17) in a consecutive series of 63 patients dying from ischaemic heart disease. Two thirds of left ventricular acute myocardial infarctions (LV-AMI's) were transmural and one third was sub-endocardial. Coronary thrombosis was seen more often in transmural than in sub-endocardial LV-AMI (p less than 0,05) whereas severe arteriosclerotic stenosis (greater than or equal to 75%) of a least two major arteries was seen more often in sub-endocardial than in transmural LV-AMI (p less than 0,05). Minor epicardial arteries showed stenosis greater than or equal to 75% in about one fifth of LV-AMI's, but ramus diagonalis from the left anterior descendent artery differed from other minor arteries and was diseased to the same extent as major arteries. Pre-mural stretches of coronary arteries seemed to be sites of predilection for thrombosis and arteriosclerotic stenosis. Myocardial rupture was only seen in hearts with thrombotic transmural LV-AMI's and with no signs of previous LV-AMI. Thrombosis of epicardial coronary veins was present in all cases of valvular heart disease furthermore in large transmural LV-AMI's. Prevalence of infarction fibrosis was higher (p less than 0,05) and post-attack survival time was shorter (p less than 0,02) in sub-endocardial than in transmural LV-AMI's. Morfologic injury to supraventricular parts of the conducting system was seldom demonstrated in cases with conducting disturbances. A clinical diagnosis of definite and probable AMI was at autopsy verified in 95% and 67% respectively.