Postmortem diagnosis of acute myocardial infarction in patients with acute respiratory failure - demographics, etiologic and pulmonary histologic analysis

Abstract

OBJECTIVES:Acute respiratory failure is present in 5% of patients with acute myocardial infarction and is responsible for 20% to 30% of the fatal post-acute myocardial infarction. The role of inflammation associated with pulmonary edema as a cause of acute respiratory failure post-acute myocardial infarction remains to be determined. We aimed to describe the demographics, etiologic data and histological pulmonary findings obtained through autopsies of patients who died during the period from 1990 to 2008 due to acute respiratory failure with no diagnosis of acute myocardial infarction during life.METHODS:This study considers 4,223 autopsies of patients who died of acute respiratory failure that was not preceded by any particular diagnosis while they were alive. The diagnosis of acute myocardial infarction was given in 218 (4.63%) patients. The age, sex and major associated diseases were recorded for each patient. Pulmonary histopathology was categorized as follows: diffuse alveolar damage, pulmonary edema, alveolar hemorrhage and lymphoplasmacytic interstitial pneumonia. The odds ratio of acute myocardial infarction associated with specific histopathology was determined by logistic regression.RESULTS:In total, 147 men were included in the study. The mean age at the time of death was 64 years. Pulmonary histopathology revealed pulmonary edema as well as the presence of diffuse alveolar damage in 72.9% of patients. Bacterial bronchopneumonia was present in 11.9% of patients, systemic arterial hypertension in 10.1% and dilated cardiomyopathy in 6.9%. A multivariate analysis demonstrated a significant positive association between acute myocardial infarction with diffuse alveolar damage and pulmonary edema.CONCLUSIONS:For the first time, we demonstrated that in autopsies of patients with acute respiratory failure as the cause of death, 5% were diagnosed with acute myocardial infarction. Pulmonary histology revealed a significant inflammatory response, which has not previously been reported.

Relevance of Autopsy As a Diagnostic Tool in Present Times: A Study

“…[13] Autopsy studies by revealing the variable histopathological changes that occur in visceral organs in different disease processes facilitate improved understanding, making future diagnosis and correlation simpler. Of the 16 cases showing histological evidence of ischemic heart disease, corresponding lung histopathology revealed pulmonary edema and diffuse alveolar damage in 71.4%, similar to Soiero AM et al, [14] reiterating the fact that lungs are secondarily involved in all forms of terminal cardiac events.…”

Cardiac Injury Biomarkers and the Risk of Death in Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Severe hypoxemia resulting from acute respiratory failure contributes to reducing oxygen supply, which would stimulate the sympathetic system and increase myocardial oxygen demand [ 39 , 40 ]. Indeed, postmortem studies have revealed that approximately 5–25% of patients who died from acute respiratory failure had experienced unobserved myocardial infarction [ 41 ]. Another possible mechanism is the proinflammatory state, where respiratory infectious agents can elicit an inflammatory pattern in atheromatous plaques [ 42 ].…”

Acute Coronary Syndromes and Covid-19: Exploring the Uncertainties

“…Acute respiratory failure with consequent severe hypoxaemia contributes to reduce oxygen supply and determines activation of the sympathetic system, which increases heart rate, cardiac output, and contractility, factors that can increase myocardial oxygen demand [ 24 , 25 ]. Incidence of myocardial injury or infarction in critically ill patients may go unrecognized [ 26 ], as post-mortem studies have suggested, where a prevalence of undiagnosed acute myocardial infarction (AMI) ranging from 5% to 25% in patients who died from acute respiratory failure was observed [ 27 , 28 ].…”