Embolism and Thrombosis in Coronary Heart Disease

Abstract

The problem of embolism and peripheral venous thrombosis has always been a major one in the treatment of heart disease and particularly of coronary heart disease. This is due to the prevalence of mural thrombi in the chambers of the heart, which may serve as a source of emboli, and to the occurrence of peripheral venous thrombi, especially in the legs. Several articles on the subject have appeared in the literature of the last few years, a splendid summary of which is given by Hellerstein and Martin,1 who also give their own observations in 160 cases of myocardial infarction occurring in a total of 2,000 autopsies at the University Hospitals in Cleveland. In 45 per cent of the cases in their series there were emboli or thrombi in other parts of the body, a total of one hundred and eleven peripheral thromboembolic lesions being found. In 12 per cent of the cases these were the main cause of death, and in another 15 per cent they were contributory causes of death. In a series of 1,146 autopsied cases collected by the aforementioned authors from the litera¬ ture up to 1947, the location of thromboembolic lesions following myocardial infarction was : lung, 23.5 per cent ; brain, 7.7 per cent ; extremities, 5.5 per cent ; kidney, 14.4 per cent; spleen, 8.8 per cent, and mesenteric vessels, 1.9 per cent. These figures include all the lesions encountered and do not, of course, represent the number of patients involved, since many showed embolism in more than one organ. Of these, pulmonary embolism is the commonest serious compli¬ cation of cardiac infarction and in the foregoing sum¬ mary was the chief cause of death in 10.6 per cent of autopsied cases.Also in 1947, Mintz and Katz,2 in a clinical analysis of 572 cases of recent myocardial infarction, found a total incidence of 52 cases of thromboembolism, of which 28 were pulmonic and 13 cerebral. In a series, as yet unpublished, of 1,000 cases of recent myo¬ cardial infarction at the Los Angeles County Hospital, Edmondson 3 observed a total of three hundred and twenty-eight manifest embolisms in some part of the body outside of the heart, and of these one hundred and sixty-one were in the lungs, forty-eight in the brain, ten in the mesenteric vessels and twenty-eight in the extremities.Most of the preceding autopsy material was reported from major cities and included a considerable per¬ centage of patients from public hospitals. With the idea in mind of summarizing the material of a smaller hospital, in a relatively small city, nearly all of the patients of which were private, the following study was made of the autopsy records of the Huntington Memorial Hospital. The autopsy percentage has remained about 65 per cent over the course of years.Since the city of Pasadena has a large proportion of persons of middle age and older, the problem of coro¬ nary heart disease is a major one. A review is made of a total of 3,900 autopsies done from January 1931 to May 1948. Of these 727 were in newborn or still¬ born infants, leaving 3,173 in older than newborn sub¬ jects. Few chi...

Platelet Consumption in Cardiovascular Disease

“…73 In contrast, coronary artery thrombosis has been shown to occur infrequently in patients with subendocardial infarction (Table 3) in which the mechanism of infarction is believed to be due to reduced regional myocardial perfusion plus severe coronary artery stenosis, rather than acute thrombotic occlusion of the epicardial artery. 168 Barnes and Ball 9 Friedberg and Horn 92 Blumgart et al 21 Foord 90 Yater et al 347 Miller et al 191 Snow et al 289 Branwood and Montgomery 36 Spain and Bradess 292 Mitchell and Schwartz 195 Ehrlich and Shinohara 81 Meadows 188 Sinapius 282 Baroldi 11 Harland and Holburn 121 Jcfrgensen et al 149 Kagan et al 153 Spain and Bradess 293 Bouch…”

“…Many patients with myocardial infarction will develop left ventricular mural thrombosis, 68,90,174,326 which may serve as a potential source of coronary artery embolization.…”

The effects of antithrombotic drugs in patients with left ventricular thrombi: assessment with indium-111 platelet imaging and two-dimensional echocardiography.

“…In this regard, a preliminary echocardiographic study of patients less than 5 weeks after infarction showed thrombus reduction or resolution in four of 10 patients treated with sulfinpyrazone (400 mg twice a day). 2 We chose sulfinpyrazone as the primary study drug since it appeared to inhibit platelet deposition in a similar model of arterial thrombosis in two of four patients with thrombi in abdominal aortic aneurysms. 25 Additionally, in randomized studies, sulfinpyrazone reduced the incidence of arteriovenous shunt thromboSiS33 and decreased the incidence of systemic embolism in patients with mitral stenosis, presumably by decreasing left atrial thrombus formation.34 In contrast.…”

Myocardial Infarction During Anticoagulant Therapy

“…What, then, is the role of coronary thrombosis in the pathogenesis of myocardial infarction? The frequency of coronary thrombosis in patients who die of myocardial infarction varies markedly in the published autopsy materials: 45 per cent ( I l ) , 53 per cent (3), 63 per cent (12), 69 per cent (8,23), 87 per cent (7), 92 per cent (18). The frequency of coronary thrombosis in all cases of death from coronary disease, both with and without myocardial infarction, is usually lower: 43 per cent (19),47percent (14),51 per cent (23), 52 per cent (5).…”