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== Clinical Summary ==
This 83-year-old white male was admitted with the chief complaint of chest pain. He had been awakened the previous night with dull chest pain which was retrosternal and radiated through to his back. The pain was associated with sweating, nausea, and vomiting and could not be relieved by antacids. Nitroglycerin gave prompt relief. Following admission he developed cardiac arrhythmias. His AST was found to be 130 IU/L. In the early morning of the day after admission, he developed severe epigastric pain and several episodes of tachycardia (150-160 beats per minute) and later cardiac standstill. He expired less than a day after admission. There was a history of hypertension and diabetes.
== Autopsy Findings ==
The heart weighed 500 grams. There was massive acute myocardial infarction (about 2 days old) involving the posterior left ventricle, interventricular septum, and right ventricle from apex to base. The infarct was transmural, and there was a small rupture in the soft infarcted area at the apex. There were 1200 mL of blood within the right pleural cavity, probably secondary to this rupture. The coronary arteries showed moderate to severe atherosclerosis throughout the coronary tree.
== Images ==
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