Cutaneous petechiae in fatal coronary artery disease.

Abstract

In the clinical recognition of myocardial ischaemia, thenatureand distribution of the referred painwhichfrequently accompanies itare ofconsiderable diagnostic importance. Unfortunately incasesofsuddendeaththeremay be no suchhistory andnotalways isan unequivocal fatal cardiac lesion found,suchas a recentor ruptured infarct, or an acuteoccluding lesion ofa coronaryartery.Insome there islittle toindicate whyor howthepatient actually died, as theonly cardiac lesions foundare oflongstanding. The fatal disturbance isoftenoffunction rather than ofstructure andinsuchcases thepost-mortem diagnosis ofacutecoronaryinsufficiency ismade byimplication rather thanobservation. Insevennecropsies on casesofacutecoronary deathcutaneous petechiae were observed atsites commonlyassociated withreferred pain of cardiac origin (Fig. 1). No suchlesions were observed inany deaths notofcoronary origin. Thesepetechiae were alloutside thearea of cutaneous post-mortem hypostasis andinno case was there any evidence ofgeneralized haemorrhagic disease. Itissuggested thatthissign may be ofdiagnostic significance inthepost-mortem diagnosis of coronary insufficiency. There appears tobeno previous description ofsimilar observations incases ofcoronary heartdisease either before or after death. CaseReports Case1.-Ahousewife aged72years diedtwo days after admission tohospital ina collapsed statewith dyspnoea andpainintheleft shoulder. Threeweeks previously shehadexperienced an attackofgripping painin theretrosternal region.Therewas no previous history ofany other illness. At necropsyfinerecentpetechiae were seen over