ABC | Volume 111, Nº6, December 2018

Anatomopathological Correlation Nunes et al Chest pain and shock in a patient with ischemic heart disease Arq Bras Cardiol. 2018; 111(6):860-863 healed transmural myocardial infarction in the left ventricular anterior and septal walls. There was wall thinning and fibrosis, with antero-apical aneurysm and thrombus at the apex (Figure 3). Signs of a previous systemic thromboembolism, with previous renal and cerebral infarctions were also found, with the latter being a cavitated infarction affecting the temporal and occipital regions of the left cerebral hemisphere. The aorta and coronary arteries showed marked atherosclerotic involvement, with ulcerated plaques in the aorta and obstructions > 70% in the initial and middle thirds of the anterior interventricular branch of the left coronary artery and between 50 and 70% in the circumflex branch of the same artery and in the right coronary artery. Signs of congestive heart failure were found in the lungs and liver. The terminal cause of death was pulmonary thromboembolism on the right, with infarction organization at the pulmonary base (Figure 4). The right pleura showed fibrin deposits and the histological analysis showed acute fibrinous pleuritis (Figure 5). There was also pleural effusion on the right (500mL of citrine-colored fluid) (Prof. Dr. Vera D. Aiello) . Anatomopathological diagnoses – Ischemic heart disease with healed transmural infarctions in the anterior wall and ventricular septum and anteroseptal aneurysm. – Apical thrombus in the left ventricle. – Systemic and coronary atherosclerosis of moderate to high degree. – Previous infarctions in the kidneys and in the temporal and occipital cortex of the left cerebral hemisphere. – Pulmonary thromboembolism on the right, with recent pulmonary infarction. – Acute fibrinous pleuritis on the right, with pleural effusion (500mL) (Prof. Dr. Vera D. Aiello) Comments The patient described herein sought emergency care with chest pain and was known to have ischemic heart disease. The clinical investigation for acute infarction was inconclusive and the patient died less than 24 hours after hospital admission. Necropsy showed previous infarctions and signs of congestive heart failure. We found no evidence of a recent infarction and attributed the chest pain to the finding of a recent pulmonary thromboembolism on the right, with pulmonary infarction and acute fibrinous pleuritis. In a study carried out at our institution, which assessed the agreement between clinical diagnoses and necropsy findings, the greatest discrepancy occurred in cases of pulmonary thromboembolism (34.1%). 5 (Prof. Dr. Vera Demarchi Aiello) Figure 3 – Cross-sections of the heart at the level of the ventricles (short axis) showing previous transmural infarctions in the anterior and septal walls (arrows). These same places show thinning of the wall and, localized slight dilatation (aneurysm). There is also a cavitary thrombus in the ventricular apex (asterisk). 862