Voigt J, Steinmetz E
Acta Pathol Microbiol Scand A. 1977 Mar;85A(2):174-82. doi: 10.1111/j.1699-0463.1977.tb00415.x.
In 9 lethal cases where clinical signs gave rise to the suspicion of acute myocardial infarct (AMI) where well-characterized e.c.g.-changes, permanent or intermittent, were found by monitoring, a very careful autopsy of the heart was carried out, combined with a meticulous histological investigation of the conduction system. Acute changes of mild degree in the conduction system were found only in one case, possibly explaining the left bundle branch block found in this case. In the remaining cases, nothing but chronic changes were found and they did not exceed significantly the changes otherwise to be found in the agegroups concerned in a "control series" of violent deaths not preceded by symptoms of heart disease. According to an estimate there was good correlation between the conduction disturbances demonstrated and the localization of histopathological changes in seven of nine patients; in one of the latter correlation was relatively good; correlation was dubious only in one case. On this basis the authors conclude that present changes in the conduction system which are assumed mainly to be age-related, are the factors to determine the type of conduction disturbances from which the patient will suffer if acute heart ischaemia sets in, for instance due to an AMI, in fact, changes by which he will be predisposed to such disturbances.
在9例因临床症状怀疑为急性心肌梗死（AMI）的致命病例中，通过监测发现了明确的心电图改变，这些改变呈持续性或间歇性。对心脏进行了非常仔细的尸检，并对传导系统进行了细致的组织学研究。仅在1例中发现传导系统有轻度急性改变，这可能是该病例中出现左束支传导阻滞的原因。在其余病例中，仅发现慢性改变，且这些改变与在无心脏病症状的暴力死亡“对照系列”中相应年龄组中发现的改变相比，并无显著差异。据估计，9例患者中有7例传导障碍与组织病理学改变的定位之间有良好的相关性；其中1例相关性相对较好；仅1例相关性不明确。基于此，作者得出结论：目前假定主要与年龄相关的传导系统改变，是决定患者如果发生急性心肌缺血（如因AMI）时会出现何种类型传导障碍的因素，实际上，正是这些改变使患者易患此类障碍。
