Acute subepicardial infarction associated with severe septic shock - insight in myocardial perfusion

作者：May Annette M; Riede Florian N; Riede Ursus Nikolaus^*

来源：Pathology Research and Practice, 2010, 206(6): 401-404.

DOI：10.1016/j.prp.2009.11.001

• Subendocardial infarction
• Myocardial hemorrhagic infarction
• Myocardial perfusion
• Sepsis
• Disseminated intravascular coagulation (DIC)

Isolated infarctions of the subepicardial myocardium without changes in subendocardium are extremely rare. We present an autoptic case with an acute subepicardial infarction of the right- and left-ventricular myocardium.
A 53-year-old male was admitted to hospital with acute upper abdominal pain. Clinical examination revealed an acute infero-lateral myocardial infarction. The patient succumbed to acute heart failure a few hours later.
Autopsy revealed numerous pulmonary abscesses due to suppurative lobular pneumonia with consecutive pericardial effusion. Furthermore, we diagnosed an acute myocardial infarct encompassing the entire right and left ventricles but limited to the subepicardial myocardium only. Microscopically, we observed fibrin microemboli in the subepicardial microvessels.
The existence of an isolated subepicardial myocardial infarct challenges our understanding of myocardial perfusion.

• 出版日期2010