title: [Traumatic heart rupture or infarct?].
abstract: A 70-year-old motorist driving on the wrong side of the road caused a car-to-car head-on collision and died some minutes later. The autopsy revealed a lethal rupture of the right heart ventricle. The insurance company argued that driving on the wrong side was an act of gross negligence so that the damage was not covered by the full comprehensive insurance. Surprisingly, the microscopic examination of the myocardium performed by a clinical pathologist brought to light a severe myofibrillar degeneration (MFD) which was interpreted as diagnostic of acute myocardial infarction. It was supposed that this could have caused an incapacity of the driver to control his car, which in turn would commit the insurance to payment. A critical re-evaluation of the heart tissue material, however, revealed the pattern of trauma-induced hypercontraction banding of the myocardium along the cleft edges but no findings suggestive of myocardial infarction. Thus, the accident was not the result of a cardiac attack. But there was a severe preexisting pathology including cardiac hypertrophy, scarring of the myocardium, siderophages of the lungs, and an infarction of the pons, so that a cerebral dysfunction was the most plausible explanation for the accident. Thus, gross negligence had to be denied, and the insurance company was obliged to pay. This observation points to the existence of two different variants of MFD: Clinical pathologists are familiar with "tyical" MFD occurring in reperfusion after ischemia, in catecholamine toxicity, and around infarct necroses. But hypercontraction banding, regularly found along penetrating heart lesions and well known to forensic pathologists, is uncommon in clinical pathology.
mesh_terms: D000063:Accidents, Traffic / Q000331:legislation & jurisprudence*; D000368:Aged; D020526:Brain Stem Infarctions / Q000473:pathology; D002423:Cause of Death; D003937:Diagnosis, Differential; D005104:Expert Testimony / Q000331:legislation & jurisprudence; D006335:Heart Injuries / Q000473:pathology*; D006342:Heart Rupture, Post-Infarction / Q000473:pathology*; D006801:Humans; D007346:Insurance, Accident / Q000331:legislation & jurisprudence; D008297:Male; D009203:Myocardial Infarction / Q000473:pathology*; D009206:Myocardium / Q000473:pathology; D011149:Pons / Q000473:pathology
vernacular_title: Traumatische Herzruptur oder Infarkt?