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Platelet aggregates in intramyocardial vessels of patients dying suddenly and unexpectedly of coronary artery disease

  • J.W. Hærem
    Correspondence
    Reprint requests to: Dr. Jørgen W. Hærem, Ullevål Hospital, Krohgstøtten, Oslo 1 Norway.
    Affiliations
    Ullevål Hospital, Department of Pathology, University of Oslo, Oslo Norway
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      Abstract

      The present study was carried out in order to explore if platelet aggregates in the intramyocardial vessels of man could play a role in the pathogenesis of sudden coronary death, especially in patients with no major lesion in the epicardial arteries. The vessels of the conduction system were of particular interest.
      The intramyocardial vessels of 54 patients were examined by microscopical screening of standard myocardial sections. The sinus- and atrioventricular nodes, the bundle of His, and the bundle branches were included in the sections. Twenty-seven patients died suddenly and unexpectedly of coronary artery disease. Sixteen patients had chronic coronary disease, but died of non-cardiac diseases. Eleven patients died without known coronary disease.
      Among patients who had no acute major lesion in the epicardial arteries, those who died suddenly of coronary disease had the highest number of intramyocardial arteries with platelet aggregates. Compared with the chronic coronary patients the difference was statistically significant.
      The platelet aggregates did not occur particularly in the vessels of the conduction system in any disease group.
      In some instances of sudden coronary death with no major acute lesion in the epicardial arteries, a hampering of the intramyocardial circulation by platelet aggregates possibly plays a role in the pathogenesis of the fatal event.

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      References

        • Moritz A.R.
        • Zamcheck N.
        Sudden and unexpected deaths of young soldiers. Diseases responsible for such deaths during World War II.
        Arch. Pathol. 1946; 42: 459-494
        • Yater W.M.
        • Traum A.H.
        • Brown W.G.
        • Fitzgerald R.P.
        • Geisler M.A.
        • Wilcox B.B.
        Coronary artery disease in men eighteen to thirty nine years of age. Report of eight hundred sixty-six cases, four hundred fifty with necropsy examinations.
        Amer. Heart J. 1948; 36: 683-722
        • Rabson S.M.
        • Helpern M.
        Sudden and unexpected natural death, Part 2 (Coronary artery sclerosis).
        Amer. Heart J. 1948; 35: 635-642
        • Branwood A.W.
        • Montgomery G.L.
        Observations on the morbid anatomy of coronary artery disease.
        Scot. Med. J. 1956; 1: 367-375
        • Spain D.M.
        • Bradess V.
        Frequency of coronary thrombus as related to duration of survival from onset of acute fatal episodes of myocardial ischemia.
        Circulation. 1960; 22: 816
        • Baroldi G.
        Acute coronary occlusion as a cause of myocardial infarct and sudden coronary heart death.
        Amer. J. Cardiol. 1965; 16: 859-880
        • Krauland W.
        Types of coronary occlusion.
        Pathol. Microbiol. 1967; 30: 709-715
        • Hærem J.W.
        Sudden coronary death: The occurrence of platelet aggregates in the epicardial arteries of man.
        Atherosclerosis. 1971; 14: 417-432
        • Jørgensen L.
        • Rowsell H.C.
        • Hovig T.
        • Glynn M.F.
        • Mustard J.F.
        Adenosine diphosphate-induced platelet aggregation and myocardial infarction in swine.
        Lab. Invest. 1967; 17: 616-644
        • Leren P.
        The effect of plasma cholesterol-lowering diet in male survivors of myocardial infarction.
        Acta Med. Scand. 1966; (Suppl.): 80
        • Lovell R.R.H.
        Rethinking coronary thrombosis: Lessons from experimental therapeutics with anticoagulants.
        Med. J. Aust. 1969; 2: 425-432
        • James T.N.
        Morphology of human atrioventricular node, with remarks pertinent to its electrophysiology.
        Amer. Heart J. 1961; 62: 656-771
        • Hudson R.E.B.
        The human conducting-system and its examination.
        J. Clin. Pathol. 1963; 16: 492-498
        • Lendrum A.C.
        • Fraser D.S.
        • Slidders W.
        • Henderson R.
        Studies on the character and staining of fibrin.
        J. Clin. Pathol. 1962; 15: 401-413
        • Maxwell A.E.
        Analysing Qualitative Data.
        in: 3rd edition. Methuen, London1967: 23-26
        • Maxwell A.E.
        Analysing Qualitative Data.
        in: 3rd edition. Methuen, London1967: 115-117
        • Hellem A.J.
        • Stormorken H.
        Platelet adhesion-aggregation reaction and its clinical significance.
        in: Poller L. Recent Advances in Blood Coagulation. Churchill, London1969: 69-106
        • Hampton J.R.
        • Mitchell J.R.A.
        Abnormalities in platelet behaviour in acute illnesses.
        Brit. Med. J. 1966; 1: 1078-1080
        • Jørgensen L.
        • Glynn M.F.
        • Buchanan M.R.
        • Mustard J.F.
        Hypertension and renal lesions induced in rabbits by platelet aggregation.
        Acta Pathol. Microbiol. Scand. 1967; (Suppl.): 54-55
        • Robb H.J.
        • Jabs C.
        Distortion and dynamics of cellular elements in the microcirculation. Description of white cell plugging, platelet aggregate embolism and red cell parachute.
        Angiology. 1968; 19: 602-611
        • Williams A.W.
        • Higginbotham A.C.
        • Melvin M.
        • Knisely M.H.
        Increased blood cell agglutination following ingestion of fat. A factor contributing to cardiac ischemia, coronary insufficiency and anginal pain.
        Angiology. 1957; 8: 29-40
        • Stalker A.L.
        Histological changes produced by experimental erythrocyte aggregation.
        J. Pathol. Bacteriol. 1967; 93: 203-212
        • Bicher H.I.
        • Beemer A.M.
        Induction of ischemic myocardial damage by red blood cell aggregation (sludge) in the rabbit.
        J. Atheroscler. Res. 1967; 7: 409-414
        • Hirsch H.
        • Gaethgens P.
        Die Entstehung von Thrombocytenaggregaten durch Extremitatenischamie beim Hund.
        Z. Ges. Exp. Med. 1965; 139: 227-237
        • Berman H.J.
        Rheological properties of the microvasculature.
        Bibl. Anat. 1965; 7: 29-34
        • Wells R.
        • Moreci A.P.
        • Rofe S.
        Dissolution of arterial platelet emboli by the microvasculature.
        Clin. Res. 1971; 19: 435