[Coronary angiographic findings in 308 patients with the clinical diagnosis of intramural myocardial infarction (author's transl)]. / Der nicht transmurale Herzinfarkt--ein diagnostisches Problem. Koronarangiographische Befunde bei 308 Patienten, bei denen klinisch di Diagnose eines nicht transmuralen Herzinfarktes gestellt worden war.

308 patients with the clinical diagnosis of intramural myocardial infarction made elsewhere were re-investigated more than eight weeks after the acute event. ECGs and pulmonary "wedge" pressures were recorded at rest and during exercise and coronary angiography performed (Sones' or Judkin's technique). In the first group (1973/74) of 77 patients, 35 (45.5%) had a normal coronary angiogram, compared with 0.7% in a control group with transmural myocardial infarction. A normal coronary angiogram was found in 85% of the 40 patients who had no angina during exercise. In a second group (1974/77) of 231 patients, there was a steady decrease in the number of patients without angina pectoris during exercise, in parallel with a decrease in the number of those with normal coronary angiograms. This change in pattern was apparently due to improved diagnosis in the referring hospitals. Of the 37 patients (first group) with angina during exercise, all but one were subsequently found to have significant coronary arteriosclerosis. It is suggested that most patients with a normal coronary angiogram had sustained a myocarditis and (or) pericarditis which produced the symptoms and the altered ECGs, leading to the misinterpretation of "intramural myocardial infarction".