AUTOPSY INCIDENCE OF PULMONARY EMBOLISM IN CORONARY HEART DISEASE

Abstract

Pulmonary embolism occurred 42 times (30%) in a group of 140 subjects who died of coronary, rheumatic, hypertensive or syphilitic heart disease in a series of 635 consecutive autopsies in an institution where the avg. age at autopsy was unusually high (60 yrs.), and where the autopsy material was preponderantly nonsurgical. Massive embolism occurred 13 times to account for 9% of these 140 deaths. Pulmonary embolism occurred in 26 of 88 cases of coronary heart disease (30%). The incidence of pulmonary embolism was the same regardless of whether or not myocardial infarction had occurred, but the incidence of massive embolism was higher in the group not showing myocardial infarction. Lung infarcts developed in 19 of 42 cases with pulmonary embolism (45%). In 13 instances of massive embolism, infarcts were found in 8. The presence of clinically diagnosed congestive heart failure did not appear to affect the incidence of pulmonary embolism in those patients who had been ill for several days or weeks prior to death. However, most of the group with pulmonary embolism which did not show clinical evidence of congestive heart failure presented some degree of congestive heart failure at autopsy. Five cases of ruptured myocardial infarcts with hemopericardium were found in the 88 cases of coronary heart disease. All of these patients had presented relatively mild initial symptoms and none had been kept at complete bed rest.