Acute Reversible Myocardial Infarction after Blood Transfusion in the Aged

Seven elderly cases with the typical electrocardiographic changes of acute myocardial infarction in the absence of myocardial infarction on postmortem examination were observed following the blood transfusion. The underlying diseases were cancer in gastrointestinal tract or gall bladder in four cases, gastric ulcer in two cases, and a case of pseudomembranous enterocolitis. The electrocardiogram revealed the abnormal Q waves with monophasic ST elevation and following coronary T inversion. These characteristic findings lasted only for 2 to 7 days and returned to the previous normal tracings. The hematocrit was elevated from 28.9 to 47.7 after the blood transfusion of 800 to 1800ml. The disseminated intravascular coagulation was shown in five cases. GOT levels were within normal ranges except in one case. Pathological findings in cases with recent electrocardiographic changes were characterized by the mural thrombi, extending into the myocardium through the thebesian vein. The focal small necroses of the adjacent myocardium and the thrombosis of small vessels were also observed. In cases with relatively long interval the fine interstitial fibrosis took place after the resorption of the thrombi and necrotic foci. From these clinical and pathological findings we proposed the new concept of reversible myocardial infarction induced from the hypercoagulability and elevated hematocrit.