ST elevation myocardial infarction gross pathology: Difference between revisions

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'''Associate Editor-In-Chief:''' {{CZ}}
'''Associate Editor-In-Chief:''' {{CZ}}
 
==Overview==
Myocardial infarctions can be classified temporally from clinical and other features, as well as according to the pathological appearance as:<ref name="pmid17951284">{{cite journal |author=Thygesen K, Alpert JS, White HD, ''et al'' |title=Universal definition of myocardial infarction |journal=Circulation |volume=116 |issue=22 |pages=2634–53 |year=2007 |month=November |pmid=17951284 |doi=10.1161/CIRCULATIONAHA.107.187397 |url=}}</ref>
Myocardial infarctions can be classified temporally from clinical and other features, as well as according to the pathological appearance as:<ref name="pmid17951284">{{cite journal |author=Thygesen K, Alpert JS, White HD, ''et al'' |title=Universal definition of myocardial infarction |journal=Circulation |volume=116 |issue=22 |pages=2634–53 |year=2007 |month=November |pmid=17951284 |doi=10.1161/CIRCULATIONAHA.107.187397 |url=}}</ref>



Revision as of 15:33, 28 May 2009

Myocardial infarction
Myocardial infarction, fibrosis. Right Coronary Artery's territory
ICD-10 I21-I22
ICD-9 410
DiseasesDB 8664
MedlinePlus 000195
eMedicine med/1567  emerg/327 ped/2520

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Overview

Myocardial infarctions can be classified temporally from clinical and other features, as well as according to the pathological appearance as:[1]

  • 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

Gross Pathological Findings

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.


Sources

  • The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction [2]
  • The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction [3]

References

  1. Thygesen K, Alpert JS, White HD; et al. (2007). "Universal definition of myocardial infarction". Circulation. 116 (22): 2634–53. doi:10.1161/CIRCULATIONAHA.107.187397. PMID 17951284. Unknown parameter |month= ignored (help)
  2. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004). "ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Revise the 1999 Guidelines for the Management of Patients with Acute Myocardial Infarction)". Circulation. 110 (9): e82–292. PMID 15339869. Unknown parameter |month= ignored (help)
  3. Antman EM, Hand M, Armstrong PW; et al. (2008). "2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee". Circulation. 117 (2): 296–329. doi:10.1161/CIRCULATIONAHA.107.188209. PMID 18071078. Unknown parameter |month= ignored (help)

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