Recent Myocardial Infarct

Clinical History

Four days prior to admission, the patient collapsed with severe central chest pain and breathlessness. An ECG showed "heart damage". The pain subsided until the day of admission when it returned and necessitated admission to hospital. The patient had been suffering from angina pectoris and had a past history of myocardial infarction 12 years previously. On examination, pulse rate 140, weak, but regular, BP unrecordable. Jugular venous congestion was present. ECG showed a recent antero-septal infarct. The patient was treated accordingly but was found dead in bed 8 days after admission. At post mortem, the heart was hypertrophied and dilated with an extensive area of recent, yellowish, coagulative necrosis in the antero-septal and postero- septal portions of the left ventricular wall.

Pathology

A slice through the apex of the heart shows extensive pale yellowish, mainly subendocardial necrosis involving more than half the thickness of the anterior wall of the left ventricle, adjacent lateral wall, and inter-ventricular septum. There is also extensive mural thrombus formation. The posterior aspect of the septum and adjacent posterior wall of the left chamber show whitish scar tissue. NB: The posterior wall of the left ventricle is uppermost.

Diagnosis

Recent antero-lateral and antero-septal myocardial infarct and fibrous scar following healed previous infarct.