Left ventricular subendocardial haemorrhages. A study of their morphology, pathogenesis and prognosis

181 medicolegal and clinicopathological autopsy cases with subendocardial haemorrhages were studied with special reference to the primary conditions which might have triggered the haemorrhages, the time interval between the onset of these conditions and death, the gross and microscopic appearances of the subendocardium and other parts of the heart and the cause of death.

There was a wide panorama of conditions associated with subendocardial haemorrhages: Trauma, poisoning, epilepsy, surgical and obstetric shock, intracranial diseases and others with the same sudden onset of a process which caused general hypoxia. Death occurred immediately or up to 24 days after the trauma or onset of the primary condition. The subendocardial haemorrhages were associated with myocytic necrosis, inflammatory reaction and vascular lesions in the entire myocardium. The subendocardial regions and the apexes of the papillary muscles were the most common sites of manifestations of the general hypoxic cardiovascular injury. The morphological alterations correlated well with the time lapse after the onset of the associated condition. In 27 cases, or 15 per cent, death was attributed to cardiovascular disturbances, presumably caused by the lesions described. In the rest of the cases, cardiovascular disturbances were not clinically registered due to the short time of survival, or were transient or absent, despite the presence of widely spread cardiovascular lesions. It is suggested that in cases with clinically transient or asymptornatic recent hypoxic cardiovascular lesions there is a possibility for a silent progression of the pathological process in chronic ischemic cardiomyopathy.