Hemorrhagic subendocardial necrosis after cardiac arrest and cardiopulmonary resuscitation

A 19 year old boy, previously healthy suffered a cardiac arrest by getting up. Ten minutes afterwards the general practioner commenced cardiopulmonary resucitation, 15 minutes later ventricular fibrillation developed and the emergency physician carried out intubation and repeated defibrillation. Dur ing the next few hours a stabilization of the circulatory system was achiev ed. Five days after the cardiac arrest brain death occurred. The postmortem findings on the heart (only a heart section was performed) showed extensiv e circular hemorrhagic subendocardial necrosis with initial organization of the left ventricular wall and the septum with a well-preserved subendocard ial area. In the right ventricular wall only a few small areas of organizat ion were observed. All lesions were consistent with the cardiac arrest suff ered 5 days previously. The morphological changes differ from those of a us ual hemorrhagic infarction and of the sequences of a cardiopulmonary resusc itation. The circular subendocardial necroses occur after a cardiac arrest which exceeds the resuscitation time of the heart. They do not respect the area of coronary distribution and their hemorrhagic component develops afte r successful reanimation within the necrotic myocardium.