(1) The 266 post -mortem records of those found to have died
from or suspected of dying from myocardial infarction in
The Royal Infirmary, Edinburgh, in 1954. and 1955 have been
reviewed.
(2) The accuracy rate in the diagnosis of myocardial infarction
is surprisingly low, being 44% when the cases only
discovered at autopsy are taken into account. The major
diagnostic errors occur in patients who died suddenly or present in an atypical way.
(3) A greater awareness of the possibility of underlying
myocardial infarction in elderly patients with unexplained
heart failure or pleural effusions, in cases with cerebrovascular accidents, and in post- operative patients whose
condition inexplicably deteriorates might lead to a decrease
in diagnostic errors.
(4) About 50 of sudden deaths are due to myocardial infarction;
and anyone who dies suddenly having given previous evidence,
either clinical or electrocardiographic, of coronary artery
disease, is almost certain to have died in this way.
The electrocardiographic diagnosis of recent myocardial
infarction is very accurate, and a clinical diagnosis alone
without electrocardiographic corroboration, when this is
available, is no longer justifiable
