Clinicopathologic aspects of ischemic heart disease in the elderly.

Abstract

Clinicopathologic correlation studies were performed to clarify the characteristic features of myocardial infarction (MI) in the elderly. A total of 203 cases of MI were found in 1, 000 consecutive autopsy of the aged. There were 113 men and 90 women with an average age of 78.5 years.There were 117 cases of large MI and 82 fresh MI. With aging, there was a tendency of decrease in ratio of large MI, and increase in middle-sized MI. When coronary stenosis of more than 75% was considered to be significant, there were 97 cases of 3 vessel disease, 51 of 2 vessel dis-ease, and 30 of 1 vessel disease; that is 178 cases (87.7%) showed significant stenosis in at least 1 vessel. Remaining 25 cases of MI had no sig-nificant coronary stenosis. In general, large MI had marked coronary stenosis. Some of the MI without significant coronary stenosis were explained by uncommon pathogenesis such as disseminated intravascular coagulation or atrial fibrillation. Incidence of coronary thrombi was the highest (76.7%) in large and fresh MI.Electrocardiographic diagnosis was correct in 65% of large fresh MI. Incidence of chest pain was 48% in large acute MI and 27.8% in middle MI, whereas various complications such as shock (60%), congestive heart failure (53.3%), and arrhythmia (65%) were frequently found. Causes of death in large acute MI were arrhythmia in 16 cases, cardiac rupture in 13, and sudden death in 8.There were 15 cases of cardiac rupture, which occurred within 5 days from the onset of acute MI in all. Site of MI and rupture was anterior in 8, inferior in 5, and lateral in 2, including 1 case of septal perforation in anterior MI. There were 21 cases of papillary muscle dysfunction. From analysis of clinical sequence of MI and mitral regurgitation, 3 types of the syndrome were classified; 15 cases due to old MI, 2 cases due to acute MI, and 4 cases of mitral regurgitation followed by MI. There were 24 cases of conduction disturbances in 82 cases of acute MI (29%). In atrioventricular (A-V) block, site of lesions in conduction system was examined by the serial sections, which was located at the A-V node in 2, A-V bundle in 4, and bilateral bundle branches in 4.