Abstract
Accurate localization of muscle damage at the autopsy is of fundamental importance for clinicopathologic correlation in coronary disease. Routine autopsy tehnique is unsuitable. Precise localization of muscle lesions requires not only thorough gross and microscopic scrutiny of the ventricular myocardium, but multiple cross-sectioning of the epicardial coronary arteries and reference to relevant clinical and electrocardiographic findings while dissecting the heart. Examinations less systematic than this fail to protect against serious errors which account for much inconsistency and confusion in the literature. Although the number of clinicopathologic studies of coronary disease is large, adequate, detailed information about the state of the heart muscle is seldom provided. Studies in which the myocardial examination has a central place, however, consistently report more lesions and show better correlation with clinical and electrocardiographic data. This investigation attempted to combine scrutiny of the ventricular myocardium with multiple precordial lead electrocardiograms and adequate clinical data in a series of 200 autopsied patients. Attempts to modify existing pathologic methods have led to a technique, deserving of wider use, whereby the ventricular myocardium is explored by serial slices. Carefully located and oriented blocks of tissue removed from gross lesions and areas under suspicion are examined microscopically to determine the extent and nature of muscle changes and the state of the coronary vessels. While unsuited to routine use, this type of examination is a necessity for every case to be included in a clinicopathologic series aimed at electrocardiographic correlation. The present paper is concerned with the principles of an adequate pathologic examination in coronary disease and with description of the method used in our studies.
Published Version
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