Pulmonary embolism in acute myocardial infarct. Clinico-anatomic study of 19 cases.

Abstract

The aim of this study was to evaluate the incidence of pulmonary embolism as the cause of death in acute myocardial infarction; to define the anatomic and clinical profile of a subset of patients deceased by pulmonary embolism; to study the localization and characteristics of pulmonary emboli. An anatomic and clinical protocol was systematically applied to the dying patients with acute myocardial infarction admitted in a CCU of an University Hospital. Therefore, 193 patients consecutively deceased by acute myocardial infarction were studied. Sixty-four clinical parameters were evaluated together with 34 anatomic parameters concerning a very discriminative anatomic study protocol. The sole exclusion criterion for necrotic study was the lack of family consent; necropsy was thus performed in 77% of patients. Therefore, we verified that the incidence of pulmonary embolism as the cause of death was 9.8%. Delay in admission as well as the interval between the onset of symptoms and death, were longer in the deceased by pulmonary embolism than in subjects showing other causes of death. Bradycardia was absent in pulmonary embolism patients, and asystole was the terminal electric accident in the great majority of cases; heart weight was greater, and biventricular infarction and right ventricular thrombosis were also more frequent in this subset of patients. In almost half of cases, pulmonary emboli were located in the main pulmonary artery, being multiple and peripheral in four.