Abstract
There are many reports which regard thrombogenic theory (Duguid) or other mechanical obstructive theories as pathogenesis of myocard infarction. These theories are true in some cases but questionable in others. Because nonthrombogenic infarction can be seen at necropsy. Moreover those areas are not wedge form but patchy, even if thrombi are found out. Yajima et al offered “Peripheral circuratory disturbance theory”; disorders of peripheral circuration rebound centripettaly and result in thickening and inhibition of blood at a point of coronary artery trunk. Constanitides has the same view, too. Kohmoto decleared thrombi and prethrombotic lesion take place at about 2.5cm. from left coronary ostium. If these are true, we must be able to find out marked changes in central side of extramular coronary artery and in contrast slight changes in periphery.
Author has examined histologically the left coronary arteries of 62 autopsy hearts (Infarction 16 cases, Hypertension 20 cases and Control 26 cases). It is detected most cases of myocard infarction and myocard fibrosis have thickened intima and/or severe medial dameges (loss of muscle fibers, fibrosis and thinning) in their central side. But in periphery these are more slight. When we discuss them, we must investigate both changes of intima and media.
According to these, author can recognize the changes as results of high internal pressure due to “rebound”. Because these have the same predilection place to thrombi and prethrombotic lesion of acute myocard infarction. And because some cases of infarction have no severe stenosis.
In regard to coronary stenosis of infarct hearts we have been able to find out not only thrombogenic ones but also atherosclerotic. Duguid's thrombogenic theory cannot be true in all cases.
