PMC6683796_01
Electrocardiogram showing sinus rhythm at 74 beats/min, left axis deviation, Q waves in V1 to V3, 1 mm ST segment elevation of V2-V3, and poor R wave progression.
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Electrocardiogram (ECG) on presentation showed sinus rhythm at 74 beats/min, left axis deviation, Q waves in V1 to V3, 1 mm ST segment elevation of V2-V3 (present in prior ECG), and poor R wave progression (Figure 1).
Transthoracic echo showing severely reduced ejection fraction of 30-35%, severe hypokinesis of mid to apical segment with more involvement of the mid anteroseptum, and anterior wall (blue arrow) with basal hyperkinesia and basal asymmetric hypertrophy of the septum (red arrow).
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A resting 2D Doppler echocardiogram was performed on admission which showed severely reduced ejection fraction of 30-35%, severe hypokinesis of mid to apical segment with more involvement of the mid anteroseptum, and anterior wall with basal hyperkinesia and basal asymmetric hypertrophy of the septum (Figure 2).
Gross pathology. A cut section of the left ventricle showing an anteriorly located, transmural slit-like rupture (1 cm x 0.8 cm) of the ventricular wall.
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The pericardial surface was smooth and tan red in colour (Figure 3).
(a) Microscopic pathology. Acute myocardial infarction, H&E, 400x. Note: neutrophilic infiltration of the myocardium, with contraction bands (arrow). (b) Myocardium, H&E, 400x, showing intraventricular haemorrhage (blue arrow).
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The neutrophilic infiltrate, haemorrhage, and contraction band necrosis can also be visualised (Figure 4).
Cut sections of coronary arteries showing patent arteries with minimal atherosclerosis.
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Most importantly, her major coronary arteries were patent with minimal atherosclerosis and without evidence of organizing thrombus (Figure 5), supporting the histopathological criteria for the diagnosis of TCM.