Transcript myocardial infarction - THRUTH ALWAYS SATISFY U ( Adeeb ul

CARDIOVASCULAR
PATHOLOGY
BY
ADEEB UL HASSAN
3RD YEAR MBBS
BOLAN MEDICAL COLLEGE QUETTA
ACTUTE MYOCARIAL INFARCTION
I TO 2 DAYS MICROSCOPIC VIEW
 This high power microscopic
view of the myocardium
demonstrates an infarction of
about 1 to 2 days in duration.
The myocardial fibers have
dark red contraction bands
extending across them. The
myocardial cell nuclei have
almost all disappeared. There is
beginning acute inflammation.
Clinically, such an acute
myocardial infarction is marked
by changes in the
electrocardiogram and by a rise
in the MB fraction of creatine
kinase.
ACUTE MYOCARDIAL INFARCTION 1 TO 2 DAYS
MICROSCOPIC VIEW
 In this microscopic
view of a recent
myocardial infarction,
there is extensive
hemorrhage along
with myocardial fiber
necrosis with
contraction bands and
loss of nuclei.
MYOCARDIAL INFARCTION 3 TO 4 DAYS
MICROSCOPIC VIEW
 This myocardial
infarction is about 3 to
4 days old. There is an
extensive acute
inflammatory cell
infiltrate and the
myocardial fibers are
so necrotic that the
outlines of them are
only barely visible.
INTERMIDIATE MYOCARIAL INFARCTION 1 TO 2
WEEKS MICROSCOPIC VIEW
 This is an intermediate
myocardial infarction of 1
to 2 weeks in age. Note
that there are remaining
normal myocardial fibers
at the top. Below these
fibers are many
macrophages along with
numerous capillaries and
little collagenization
HEART TRANSMURAL MYOCARDILA
INFARCTION WITH RUPTURE &
HEMOPERICARDIUM GROSS APP
 One complication of a transmural
myocardial infarction is rupture of
the myocardium. This is most
likely to occur in the first week
between 3 to 5 days following the
initial event, when the myocardium
is the softest. The white arrow
marks the point of rupture in this
anterior-inferior myocardial
infarction of the left ventricular
free wall and septum. Note the dark
red blood clot forming the
hemopericardium. The
hemopericardium can lead to
tamponade
TRANSMURAL MYOCARDIAL INFARCTION
WITH RUPTURE GROSS
 In cross section, the point
of rupture of the
myocardium is shown
with the arrow. In this
case, there was a previous
myocardial infarction 3
weeks before, and another
myocardial infarction
occurred, rupturing
through the already thin
ventricular wall 3 days
later.
HEART REMOTE MYOCARDIAL INFARCTION
MEDIUM POWER MICROSCOPE
 There is pale white
collagen within the
interstitium between
myocardial fibers.
This represents an area
of remote infarction.
HEART REMOTE MYOCARDIAL INFARCTION
LOW POWER MICROSCOPE
 The myocardium
beneath the
endocardial surface at
the top demonstrates
pale fibrosis with
collagenization
following healing of a
subendocardial
myocardial infarction.
HEART REMOTE MYOCARDIAL INFARCTION
 The heart is opened to
reveal the left ventricular
free wall on the right and
the septum in the center.
There has been a remote
myocardial infarction that
extensively involved the
anterior left ventricular
free wall and septum. The
white appearance of the
endocardial surface
indicates the extensive
scarring
HEART LEFT VENTRICULARANEURYSM GROSS
 There has been a previous
extensive transmural myocardial
infarction involving the free wall of
the left ventricle. Note that the
thickness of the myocardial wall is
normal superiorly, but inferiorly is
only a thin fibrous wall. The
infarction was so extensive that,
after healing, the ventricular wall
was replaced by a thin band of
collagen, forming an aneurysm.
Such an aneurysm represents noncontractile tissue that reduces
stroke volume and strains the
remaining myocardium. The stasis
of blood in the aneurysm
predisposes to mural thrombosis.
HEART LEFT VENTRICULARANEURYSM GROSS
 A cross section through
the heart reveals a
ventricular aneurysm with
a very thin wall at the
arrow. Note how the
aneurysm bulges out. The
stasis in this aneurysm
allows mural thrombus,
which is present here, to
form within the aneurysm.
HEMOPARICARDIUM WITH CARIC TEMPONADE
GROSS
 An aortic dissection
may lead to
hemopericardium
when blood dissects
through the media
proximally. Such a
massive amount of
hemorrhage can lead
to cardiac tamponade.
THANK U VERY MUCH
 BY
 ADEEB UL HASSAN
 3RD YEAR MBBS
 BOLAN MEDICAL COLLGE
QUETTA