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This 3757-year-old white female with a 22 year history of insulin-dependent diabetes was admitted to the hospital 10 hours prior to death complaining of chest pain and shortness of breath. Three months before, she had begun to experience progressive weakness and for the previous 3 weeks she noticed increasing dyspnea on exertion and worsening of a chronic cough. Despite appropriate care she developed an intractable arrhythmia and could not be resuscitated.  Autopsy showed a 340-gram heart with extensive transmural reddish discoloration of the anterolateral portion of the myocardium of the left ventricle. There was severe atherosclerotic narrowing of all coronary arteries and an acute thrombus in the left anterior descending. The lungs showed pulmonary edema and early bronchopneumonia.