Heart failure in coronary artery disease: review of medical certificates of cause of death

The role of heart failure (HF) in mortality rates is ambiguous, and much depends on assessment criteria and accounting potential.Aim. Using medical certificates of cause of death (MCCD), to assess rates of HF, taking into account different types of coronary artery disease (CAD), sex, age and place of death.Material and methods. Data on deceased persons for 2020 were obtained from the electronic database of the Main Department of Civil Registry Office of Moscow Oblast, using the 4-digit codes of the International Classification of Diseases, Tenth Revision (ICD-10). All deaths with CAD codes (I20-25) were selected. A total of 23193 deaths were included in the analysis. The codes and verbal descriptions of complications were assessed and 3 groups were formed: without indication of heart failure (HF), with indication of HF (without chronic HF) and CHF in MCCD. Comparison of the average age of deceased, the proportion of women and men, the detection rates of certain CAD types and the place of death was carried out. Using logistic regression, the probability of chronic HF/HF as a death cause was determined, taking into account other factors.Results. Any HF was indicated in 78,9% of the MCCD (acute CAD — 44,5%, chronic CAD — in 89,1%). Chronic HF was indicated in 27% of the MCCD (men, 30,9%; women, 22,9%; p<0,0001). The highest values were obtained in heart aneurysm — 47%; in other chronic CAD forms — slightly more than a third of the MCCD. HF was not indicated in men in 23,3% of deaths, in women — in 19%; maximum — 90% in “other acute CADs”; minimum — 11% in heart aneurysm. Average age of deceased was 73,6±12,5 years (men, 68,8±10,5; women, 78,4±12,5) (p<0,0001). In all CAD forms, the average age of deceased was significantly higher in subgroups with chronic HF than in groups with (not chronic HF) or without HF. Age, sex, CAD type, place of death (in-hospital deaths were ~2 times less common).Conclusion. According to the MCCD data, chronic HF is not the dominant complication leading to death. The results obtained require clarification in studies based on primary medical documentation.

Surgical treatment of postinfarction of the left ventricular aneurism, complicated by massive pulmonary embolism

Postinfarction heart aneurysm is one of the most dangerous complications of acute myocardial infarction, determining high mortality rates. Despite the improvement of modern diagnostic methods, as well as the modernization of the system for providing highly specialized medical care to patients with acute coronary syndrome, the issues related to this issue have not lost their relevance. The publications available at this time are few and relate only to specific cases that demonstrate the advantages of a particular type of surgical correction. This clinical observation demonstrates a tactical approach to a patient with acute thrombosed postinfarction aneurysm of the upper left ventricle, when postoperative period was complicated by the development of a massive pulmonary embolism. The obtained results of stage-by-stage surgical treatment clearly show the effectiveness of the active surgical approach in relation to patients with a high premorbid profile.

HEART ANEURYSM IN CHAGAS' DISEASE

This prospective study on 41 autopsy collected human hearts concerns the "apical" lesion in Chagas' disease. Previous report did not show a correlation between lesion frequency and heart weight then discarding a vascular factor in its pathogenesis. The present paper involves other variables besides the heart weight to evaluate the relative coronary insufficiency. Distinct colored gel (green and red) injected through the capillary beds of both coronary arteries defined the extent of both vessels before separating the atria and removing the sub-epicardium fat. The Right Ventricle (RV) and Left Ventricle (LV) free walls furnished the RV/LV mass ratio. The myocardium mass colored green (right coronary artery - RC) and the whole Ventricular Weight (VW) determined the RC/VW mass ratio. The heart weight plus these mass ratios, graded and added, composed a score inversely proportional to the myocardium irrigation condition. It intended to be a more sensitive morphologic evaluation of the relative ischaemia to correlate to the apical lesion. This study showed a right deviation for the relative accumulated frequency of lesions plotted as a score function and a significant difference for higher scores in hearts with aneurysm. It suggests a ischaemic factor intervening in the apical lesion pathogenesis in Chagas' cardiopathy.

A case of intravital diagnosis of a heart aneurysm

Despite the comparatively rich sectional material, which has been sufficiently studied pathoanatomically, the intravital diagnosis of an aneurysm of the heart itself is still rarely described. Pletnev., Who collected 300 published cases, found only eight (of them 4 of his own), where the diagnosis of heart aneurysm was made during his lifetime .. In the subsequent literature there is also a report by Laird M., Morris, Sabot about heart aneurysms, clinically, however, not recognized and being only random sectional finds. Jaksch-Wartenhorst in 1928 published his 2nd case of intravital diagnosis based mainly on the X-ray picture of the disease. Dr. Ivanov in 1929 also reported two cases diagnosed by him as an aneurysm of the heart, of which one was not confirmed by autopsy, and in the second case, instead of the suspected aneurysm of the right ventricle, an aneurysm of the interventricular septum was found at autopsy.