Myocardial rupture as a complication of acute myocardial infarction: an autopsy finding.

TRABAJO LIBRE SOMETIDO AL III CONGRESO DE CIENCIAS FORENSES DE HONDURAS DEL 8 AL 10 DE OCTUBRE, TEGUCIGALPA, HONDURAS.

Abstract

Forensic History: Male, 64 years old, with no past medical history. Family members report that the deceased had experienced back pain a week earlier, for which he went to a health center where he was treated symptomatically (the medication is unknown). Yesterday, he experienced the same symptoms again, where he was treated symptomatically. Upon arriving home, the pain worsened, and he died at 10:30 p.m. The cause of death was cardiac tamponade, and the manner of death was natural. Relevant autopsy findings were:
1. Hemopericardium of approximately 500 ml.
2. Coronary atherosclerosis with involvement of the left coronary artery and the left anterior descending coronary artery, the latter involving approximately 50% of the vessel lumen, with no thrombosis.
3. Myocardial rupture of the left ventricular free wall (Figure 2).
4. Atherosclerotic plaques in the thoracic and abdominal aorta (Figure 3).

Discussion: Coronary artery disease is characterized by impaired blood flow in the coronary arteries, usually due to the formation of atherosclerotic plaque (atherosclerosis). This plaque can thrombose and lead to myocardial infarction (MI). In approximately 10% of patients, MI may occur without thrombosis and be due to other causes, e.g., coronary vasospasm. In this case, atherosclerosis was observed in the left coronary artery and the left anterior descending artery (LAD), affecting approximately 50% of the lumen of the former. Extraordinary progress has been made that has considerably reduced mortality from acute myocardial infarction; however, out-of-hospital mortality is considerably higher, as reflected in this case, which could have had a better outcome with timely diagnosis. The main causes of death in patients with MI are cardiac arrhythmias and mechanical complications that develop cardiogenic shock, one of which is myocardial rupture (MR), which results in hemopericardium and rapidly fatal cardiac tamponade. 2,3. MR is an infrequent complication (1-5% of cases), and can affect the interventricular septum, papillary muscles, and the anterior or free wall of the ventricle, with the left ventricular free wall being the most frequent location. It usually occurs within 3-7 days post-infarction and represents a mortality rate of 89%. 1,2,3