Acute Myocardial Infarction
Thirty-six hours prior to admission, this 34 year old man, whilst shifting a barrow of concrete, experienced a "sudden twinge of pain". One hour later, there was the sudden onset of shortness of breath which became progressively worse. On admission the patient was cyanosed, systolic blood pressure 60 mm, pulse 100 and of poor volume. A triple rhythm was present and the patient was found to be suffering from pulmonary oedema. There was no peripheral oedema. ECG showed an infarction of the lateral wall of the ventricle. There was rapid deterioration and death.
The specimen is of a portion of the antero-lateral wall of the left ventricle sliced across and of dissected coronary vessels superiorly. The cut surface of the lateral half of the anterior wall of the left ventricle shows yellowish area surrounded by some patchy haemorrhagic spots 1-2 cm in diameter. The yellow area involves almost the whole thickness of the ventricular wall and the portion shown is 3 cm in length. There is some adherent mural thrombus present posteriorly. The coronary vessels are atheromatous and the sectioned vessel superiorly shows antemortem thrombus occluding the lumen. This is an example of coronary occlusion with resultant myocardial infarction.