THE INCIDENCE OF HEART DISEASE IN 2,000 CONSECUTIVE AUTOPSIES

Publisher Website
Google Scholar
Abstract
The protocols of 2,000 consecutive autopsies performed at the Institute of Pathology, Western Reserve University, from 1935 to 1940, were reviewed in order to determine the incidence of the various diseases of the heart. Eighty % were white, and 20% negro; 64% [male][male] and 36% [female] [female] . The age curve of this series was similar to that of deaths from all causes in the U. S. Registration area for 1940 49.2% of the patients had some cardiac lesion at autopsy, although not all were sufficiently important to have contributed to death. Nineteen % of the total autopsy population died directly of heart failure. The cardiac lesions were divided into 4 main groups: rheumatic heart disease, hypertensive heart disease, coronary artery disease, and a miscellaneous group. The age, sex, color distribution of 120 cases of rheumatic heart disease was presented. The mitral valve was involved in every case, and aortic in 85, the tricuspid in 53 and the pul-monic in 15. Forty-nine (41%) cases of rheumatic carditis lived to be 45 yrs. old or more. There were 16 cases of endocarditis lenta among the 120 cases of rheumatic heart disease (13%). The coronary arteries were significantly diseased in 51% of the 984 cases with heart lesions, or 25% of the total autopsy series. The heart was enlarged in 69% of cases with coronary artery disease. The importance of arteriosclerosis, thrombosis, and intramural hemorrhage in producing occlusion of the coronary arteries is discussed. 84% of the lesions occurred in the proximal parts of the main arteries. Multiple occlusions were found in many cases. The right coronary artery was implicated in 35%; the left anterior descending artery in 70% of all cases. Eighty-four % of cases with coronary thrombosis also had myocardial infarcts, 16% died without myocardial infarcts, many of them suddenly, within 3 hrs. of the earliest onset of clinical symptoms and before morphologic infarcts developed. The factors concerned in sudden death following coronary obstruction were severe generalized coronary arteriosclerosis, and multiple occlusions with occlusion of the predominant artery. The incidence of myocardial infarcts in the total autopsy series was 8.2%. The pertinent data were analyzed as to incidence, etiology of occlusions, location of infarcts, site of occlusion, correlation of occlusion and infarcts, and associated lesions in the heart. Single infarcts were more common in [male] [male] than [female] [female] ; multiple infarcts were proportionately more common in [female] [female] than [male][male] infarcts were relatively more common in colored than white [female] [female] ; fewer infarcts were found in negroes than would be expected from the race incidence. The left ventricle was the most frequent site of an infarct; infarcts were also found in the right ventricle, and both atria. The problem of infarction at a distance is discussed. The most common cardiac complications of myocardial infarction were mural thrombi (40%), fibrinous pericarditis (28% of recent myocardial infarcts), subsequent myocardial infarcts (32%), aneurysm formation (22%), and cardiac rupture (4%). Peripheral thrombo-embolism occurred in 45% of cases of myocardial infarcts, and were a main or contributory cause of death in 43 of 160 cases.