1978 Volume 15 Issue 3 Pages 228-234
Clinical presentations of AMI were compared in two groups of autopsied aged cases. Group I included 12 cases (7 men and 5 women, mean age of 79.8 Years) with hematological evidences of DIC and Group II 41 cases (21 men and 20 women, mean age of 77.7 years) in whom no evidence of DIC was documented.
Incidence of initial major symptoms of AMI in Groups I and II were as follows: Chest pain, 33% and 50%; dyspnea, 9% and 17%; hypotension or shock, 17% and 12%; disturbance of central nervous system, 8% and 5%; arrhythmia, 0% and 3%. Asymptomatic AMI was more frequently observed in Group I (33%) than in Group II (13%).
Unequivocal elevation of serum enzymes was observed in 16% of Group II. Equivocal elevation or no detectable change in serum enzymes was observed in the majority of cases in Group I.
Electrocardiographic changes and their sequences were characteristic for AMI in 33% of Group I and 78% of Group II, while in the majority of cases in Group I electrocardiographic changes were either atypical or not diagnostic for AMI.
In Group I cardiac death was encountered in only 33% and the remainder died of renal failure, cerebrovascular accident or gastrointestinal bleeding. In Group II, cardiac death was the major cause of death (80%).
Atypical clinical presentations of AMI complicating DIC may reflect the pathogenesis of myocardial lesions in DIC in aged patients.