Gross Description -- Substernal Chest Pain


Postmortem examination showed a very large right coronary artery; it continued in the posterior atrioventricular groove past the septum and over the left heart, supplying the posterolateral left ventricle, after having given off a large posterior descending artery. This right coronary artery was obstructed to a probe 1.6 cm from the ostium and heavily calcified. The left coronary artery was obstructed to a probe 3 cm from the ostium. The small left circumflex coronary artery tapered to an undissectable size before reaching the lateral left ventricular wall. Following dissection from the heart, fixation and decalcification, serial sectioning of the coronary arteries revealed severe, approximately 90% lumnal narrowing of the proximal right coronary. The left circumflex coronary artery had severe atherosclerosis producing up to 90% lumenal narrowing. The left anterior descending coronary artery had moderate had focally severe, approximately 75%, narrowing.

The heart was mildly enlarged; it weighed 570 grams. The epicardium was smooth. The endocardium was thin and translucent. The heart valves were thin, pliable and free of vegetations. The heart showed mild four-chamber dilatation and diffuse severe softening ("flabbiness") of the myocardium. Sectioning the heart revealed extensive pallor of the myocardium, which was transmural and maximal in the apex. The cardiac apex was focally thinned to 0.6 cm. The pallor was minimal in the upper anterior left ventricle, and there was focal mottling of the muscle in the high portion of the septum.




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