The Post-Mortem Demonstration of Early Myocardial Infarction

Abstract Ischemic heart disease is one of the leading causes of morbidity and death worldwide. Consequently, myocardial infarctions are often encountered in clinical and forensic autopsies, and diagnosis can be challenging, especially in the absence of an acute coronary occlusion. Precise histopathological identification and timing of myocardial infarction in humans often remains uncertain while it can be of crucial importance, especially in a forensic setting when third person involvement or medical responsibilities are in question. A proper post-mortem diagnosis requires not only up-to-date knowledge of the ischemic coronary and myocardial pathology, but also a correct interpretation of such findings in relation to the clinical scenario of the deceased. For these reasons, it is important for pathologists to be familiar with the different clinically defined types of myocardial infarction and to discriminate myocardial infarction from other forms of myocardial injury. This article reviews present knowledge and post-mortem diagnostic methods, including post-mortem imaging, to reveal the different types of myocardial injury and the clinical-pathological correlations with currently defined types of myocardial infarction.

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Vascular insights into the treatment of acute myocardial infarction by post-mortem in situ microcomputed tomography and histology

European Heart Journal ◽

10.1093/eurheartj/ehq122 ◽

2010 ◽

Vol 31 (15) ◽

pp. 1935-1935 ◽

Cited By ~ 2

Author(s):

Timothy C. Ball ◽

Jason R. Foerst ◽

Marc Vorpahl

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Microcomputed Tomography ◽

Post Mortem

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A Novel Method using Long Axis Cardiac MRI Measurements can Improve in vivo Myocardial Infarct Quantification

10.21203/rs.3.rs-899871/v1 ◽

2021 ◽

Author(s):

Jacob Ref ◽

Sherry Daugherty ◽

Ikeotunye Royal Chinyere ◽

Janan Zeng ◽

Jordan J Lancaster ◽

...

Keyword(s):

Myocardial Infarction ◽

Infarct Size ◽

Cardiac Mri ◽

Quantitative Assessment ◽

Post Mortem ◽

Reference Standard ◽

Segment Model ◽

Organ Harvesting ◽

Novel Method ◽

Histopathologic Analysis

Abstract PurposeCurrently, the American Heart Association (AHA) 17-segment model is the preferred clinical method to define and quantify left ventricle (LV) myocardial infarction (MI) size. This method is subjective and can be inaccurate given that segmental approximation assumes a specific percent of infarcted tissue when compared to reference standard post-mortem histopathology. To improve the accuracy and reproducibility of infarct volume quantification we propose a novel measurement technique based on cardiac MRI images from a porcine model of myocardial infarction. Data were collected from serial MRI exams of Yucatan mini swine over 6 months and endpoint organ harvesting for histopathologic analysis. MethodsTwo observers evaluated four infarct sizing methods: myocardial contouring of post-mortem heart slices, contouring using cardiac MRI, AHA 17-segment model analysis and novel long-axis MRI infarct sizing. ResultsLV infarct sizes ranges were 1.6% - 25.8% (n=10) using reference standard histopathologic infarct sizing. Intraclass correlations (ICC) were calculated between two observers and averaged due to high similarity, ICC > .900. A t-test of .0006 and Bland-Altman plots show statistically significant differences in 17-segment model infarct size compared to histopathologic analysis while no significant difference was found when compared to our new novel method with 0.8198. Linear correlation showed an R 2 of 0.9111 between MRI contoured infarct size and our novel MRI infarct sizing model to predict infarct size as a percentage while the R 2 of the 17-Seg model is 0.8197. ConclusionsThe 17-sgement model provides an inferior quantitative assessment of LV infarct size compared to the proposed long-axis infarct sizing suggesting it maybe a robust and easily implementable quantitative assessment of LV infarct size in advanced imaging.

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Purulent Pericarditis following Myocardial Infarction

Scottish Medical Journal ◽

10.1177/003693308402900311 ◽

1984 ◽

Vol 29 (3) ◽

pp. 191-192

Author(s):

D. O'Neill ◽

H. Brebner ◽

G. Watkinson

Keyword(s):

Myocardial Infarction ◽

Staphylococcus Aureus ◽

Drug Therapy ◽

Antibiotic Therapy ◽

Terminal Illness ◽

Post Myocardial Infarction ◽

Intravenous Drug ◽

Purulent Pericarditis ◽

Post Mortem ◽

Venous Cannula

A 75-year-old man required prolonged intravenous drug therapy for post-myocardial infarction arrhythmias and developed infection with Staphylococcus aureus at the site of his indwelling cannula. He received prompt antibiotic therapy but was readmitted to hospital five weeks later with a terminal illness which proved at post-mortem to be a staphylococcal pleuropericarditis. We consider that this fatal infection orginated at his venous cannula site. The problems of diagnosis are discussed.

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Study on the Specificity of Fibronectin for Post-Mortem Diagnosis of Early Myocardial Infarction

Medicine Science and the Law ◽

10.1177/002580240204200303 ◽

2002 ◽

Vol 42 (3) ◽

pp. 195-199 ◽

Cited By ~ 11

Author(s):

Bing-Jie Hu ◽

Yu-Chuan Chen ◽

Jia-Zhen Zhu

Keyword(s):

Myocardial Infarction ◽

Hemorrhagic Shock ◽

Organophosphate Poisoning ◽

Positive Staining ◽

Image Analysis System ◽

Post Mortem ◽

Cardiac Contusion ◽

Analysis System ◽

Myocardial Injuries ◽

Mechanical Asphyxia

In order to investigate the specificity of fibronectin (Fn) in the post-mortem diagnosis of myocardial infarction, the changes of Fn staining in normal, infarcted and other non-infarcted myocardial injuries resulting from myocarditis, mechanical asphyxia, electrocution, hemorrhagic shock, cardiac contusion and organophosphate poisoning were studied with an immunohistochemistry and image analysis system. The results showed that positive Fn staining could only be observed in groups of myocardial infarction and myocarditis, but could not be found in groups of mechanical asphyxia, electrocution, hemorrhagic shock, cardiac contusion, and organophosphate poisoning. Our findings indicate that positive staining of Fn in cardiomyocytes could be affected only by myocarditis, so it is quite specific for the diagnosis of myocardial infarction.

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