The accuracy of diagnosis of myocardial infarction: a clinico-pathological study

(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