23032              MYOCARDIAL INFARCT

The patients was a women aged 67 who had central chest pain for several days, but remained active and undertook considerable muscular exercise.  She collapsed after an episode of severe chest pain and was admitted in cardiac shock.  Electrocardiography confirmed an extensive inferior myocardial infarct and there was fluctuating right and left bundle branch block.  She died 8 hours after admission.  At postmortem the pericardial cavity contained 300 mls of blood.

The specimen consists of the upper portion of the heart which has been divided in the horizontal plane.  A small area of discoloured muscle can be seen on the internal half of the posterior wall of the left ventricle, near the septum, representing an area of recent infarction.  There is a recent haematoma involving the posterior part of the muscular septum, and blood has separated the myocardial fibres of the posterior wall of the right ventricle (towards the left of the specimen) to rupture externally through the posterior wall of the right ventricle.  Histology shows intense polymorphonuclear infiltration among the necrotic cardiac muscle cells.