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Sixty-four elderly autopsy cases with acute myocardial infarction (AMI) were investigated in Nagoya Koseiin Geriatric Hospital. First AMI was observed in 35 cases, and recurrent AMI in 29. The primary causes of death were cardiac rupture and congestive heart failure in the first AMI and the recurrent AMI, respectively. The most frequent ECG findings before AMI were ischemic ST-T-change (57%) and Q-QS abnormality (41%) on the first and recurrent AMI, respectively. The ECG findings were normal in 6 (21%) of 29 recurrent MI cases. There was a tendency towards Q-QS abnormality in large size old MI, but not in small size MI. In 29 cases with recurrent AMI, the positional relationship between the old MI and the AMI was classified into 3 groups of different area, same area, and different and same area according to the Maccarie classification. The frequency in our cases was similar in the 3 groups. Ten cases with different area were further classified into 3 groups, i.e. opposite, adjacent, and opposite and adjacent. Opposite cases consisted of 4 (40%) cases, while opposite and adjacent consisted of 6 (60%). It is suggested that the recurrent AMI is more likely to be fatal when AMI occurs opposite to a previous lesion rather than adjacent to an old lesion.

The relation between ECG findings and lesions of acute and old myocardial infarction in autopsy cases.