ST elevation myocardial infarction gross pathology

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Gross Pathology

Myocardial infarction can be classified temporally from clinical and other features, as well as according to the pathological appearance as:

• Evolving phase of myocardial infarction: (>6 hours),
• Acute phase of myocardial infarction: (6 hours – 7 days),
• Healing phase of myocardial infarction: (7–28 days),
• Healed phase of myocardial infarction: (29 days and beyond).

Time from Onset and Gross Morphologic Finding Relations:

• 18 - 24 hours: Pallor of myocardium
• 24 - 72 hours: Pallor with some hyperemia
• 3 - 7 days: Hyperemic border with central yellowing
• 10 - 21 days: Maximally yellow and soft with vascular margins
• 7 weeks: White fibrosis

Images

Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology

Acute Myocardial infarction.	Myocardial infarction, fibrosis. Right Coronary Artery's territory.

Acute Myocardial infarction; Posterior wall.	Gross example of myocardial infarction that is several weeks or perhaps months of age.

Acute myocardial infarction. Multi sliced view.	Gross example of acute infarction in fixed heart. Lesion is reflow necrosis stone heart also has old scar. Multisliced view.

Old myocardial infarction with fibrosis and apical thrombus.	Old myocardial infarction with fibrosis.

Acute myocardial infarction with epicardial fibrin.	Myocardial infarction and rupture.

Myocardial infarction; free wall, 6 days old, in a patient with diabetes mellitus and hypertension.	Myocardial infarction free wall, 6 days old, in a patient with diabetes mellitus and hypertension.

Anterior surface of the heart in patient with acute posterior myocardial infarction.	Posterior surface of the heart in patient with acute posterior myocardial infarction.

Old myocardial infarction with aneurysm formation	Myocardial Infarction: Gross; Left ventricle; a mural thrombus.

Myocardial Infarction: Gross; An excellent example of all ventricular slices in case of healing posterior and healed anterior myocardial infarction. A mural thrombus at apex.	Myocardial Infarction: Gross; A ventricular slice near apex; Large old anterior and posterior transmural infarctions with mural thrombosis.

Myocardial Infarction: Gross; External view showing indented area represent small posterior wall aneurysm.	Myocardial Infarction: Gross; close-up view of anterior wall of left ventricle with dimpling due to aneurysm. Surrounding hyperemia indicates acute infarction.

Myocardial Infarction: Gross; healed lesion with mural thrombus (an excellent example)	Myocardial Infarct Scar: Gross; natural color; very large old anterior infarct with wall thinning, mild aneurysm and endocardial thickening. A typical lesion.