出血性梗塞が原因と考えられた急性心筋梗塞後心破裂の2剖検例

Two cases of cardiac rupture after myocardial hemorrhagic infarct

　心筋梗塞の既往のない65歳と70歳の男性が，突然の胸痛を主訴としてそれぞれ第1病日と第4病日に死亡した。剖検の結果，これら2例は急性心筋梗塞後心破裂による死亡であり，2例ともに広汎な出血性心筋梗塞が観察された。出血性梗塞は貫壁性で中央部には心筋の亀裂が認められた。出血性梗塞は出血による心筋の離開を来たし，梗塞の治癒過程を遅延させることから，本例の心破裂の原因として出血性梗塞の関与が示唆された。

Two patients, both of whom were men over 65 years of age who had no history previous myocardial infarcts, had sudden chest pain. One of the men died due to cardiogenic shock on the first day, and the other died on the fourth hospital day. Each au-topsy disclosed transmural myocardial infarct with hemorrhage, resulting in cardiac rupture. Hemorrha-ge was recognized in the necrotic area of the myo-cardial infarcts. Each cardiac rupture was found in the center of the hemorrhagic infarcts. The ruptu-res were tear-like slits. The healing process of the infarct was much more delayed in the hemorrhagic area than in the anemic area.

These two cases suggest that hemorrhagic infarct may be one of the risk factors of cardiac ruptures.