Explore images of heart tissue from a patient who experienced multiple myocardial infarcts that occurred at different times.

The deceased patient is a 61-year-old female with a medical history of coronary artery disease, heart failure, type II diabetes mellitus, and chronic obstructive pulmonary disease.

The patient arrived at the ED with respiratory distress from influenza A and experienced a cardiac arrest with pulseless electrical activity (PEA arrest) from which she was succesfully resuscitated. However, following PEA arrest, she did not recover consciousness and began displaying upper and lower bilateral extremity twitching; during a neurologic exam, she displayed trace corneal responses and reactive pupils. An electroencephalogram confirmed status epilepticus. She was administered multiple anti-epileptic medications but continued to have breakthrough seizures. CT scans and x-rays were also concerning for pneumonia, and sputum culture was positive Pseudomonas aeruginosa. The patient was placed on broad spectrum antibiotics.

In addition to infection and seizures, the patient developed sinus tachycardia with significant ST depression, indicating acute ischemia. Given the multiple severe ongoing clinical issues and poor prognosis, a collective decision by the family was made to transition the goals of care to “comfort measures”. She passed away the same day.

Below are multiple tissue sections from the patient’s heart extracted at autopsy. Present are multiple myocardial infarctions, occurring days (acute), weeks (subacute), and years (remote) prior to death, in both the left and right ventricles along with severe atherosclerosis in the arteries.

A20: left circumflex artery A18: left anterior descending artery A19: left anterior descending artery A4: posterior left ventricle A5: posterior left ventricle A6: posterior left ventricle A2: anterior left ventricle A7: lateral left ventricle A3: interventricular septum A8: right ventricle A17: mid distal right coronary artery A1: left atrium