ST elevation myocardial infarction gross pathology: Difference between revisions

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==Images==
===Images===
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
[http://www.peir.net Images courtesy of Professor Peter Anderson DVM PhD and published with permission © PEIR, University of Alabama at Birmingham, Department of Pathology]
{| align="center"
!
|-valign="top"
| [[Image:Image15001.jpg|left|thumb|400px|Acute Myocardial infarction.]]


[[Image:Image15001.jpg|left|thumb|400px|Acute Myocardial infarction.]]
| [[Image:Image15533.jpg|left|thumb|400px|Myocardial infarction, fibrosis. Right Coronary Artery's territory.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Image15973.jpg|left|thumb|400px|Acute Myocardial infarction; Posterior wall.]]


[[Image:Image15533.jpg|left|thumb|400px|Myocardial infarction, fibrosis. Right Coronary Artery's territory.]]
| [[Image:Image917.JPG|left|thumb|400px|Gross example of myocardial infarction that is several weeks or perhaps months of age.]]  
|}


{| align="center"
!
|-valign="top"
| [[Image:Image919.JPG|left|thumb|400px|Acute myocardial infarction. Multi sliced view.]]


[[Image:Image15973.jpg|left|thumb|400px|Acute Myocardial infarction; Posterior wall.]]
| [[Image:Image905.JPG|left|thumb|400px|Gross example of acute infarction in fixed heart. Lesion is reflow necrosis stone heart also has old scar. Multisliced view.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Old MI.jpg|left|thumb|400px|Old myocardial infarction with fibrosis and apical thrombus.]]


[[Image:Image917.JPG|left|thumb|400px|Gross example of myocardial infarction that is several weeks or perhaps months of age.]]  
| [[Image:Old MI with fibrosis.jpg|left|thumb|400px|Old myocardial infarction with fibrosis.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:AMI with epicardial fibrin.jpg|left|thumb|400px|Acute myocardial infarction with epicardial fibrin.]]


[[Image:Image919.JPG|left|thumb|400px|Acute myocardial infarction. Multi sliced view.]]
| [[Image:Ruptured MI.jpg|left|thumb|400px|Myocardial infarction and rupture.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:MI and DM.jpg|left|thumb|400px|Myocardial infarction; free wall, 6 days old, in a patient with [[diabetes mellitus]] and [[hypertension]].]]


[[Image:Image905.JPG|left|thumb|400px|Gross example of acute infarction in fixed heart. Lesion is reflow necrosis stone heart also has old scar. Multisliced view.]]
| [[Image:MI and DM 2.jpg|left|thumb|400px|Myocardial infarction free wall, 6 days old, in a patient with [[diabetes mellitus]] and [[hypertension]].]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Anterior surface in APMI.jpg|left|thumb|400px|Anterior surface of the heart in patient with acute posterior myocardial infarction.]]


[[Image:Old MI.jpg|left|thumb|400px|Old myocardial infarction with fibrosis and apical thrombus.]]
| [[Image:Posterior surface of APMI.jpg|left|thumb|400px|Posterior surface of the heart in patient with acute posterior myocardial infarction.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Old MI with aneurysm.jpg|left|thumb|400px|Old myocardial infarction with aneurysm formation]]


[[Image:Old MI with fibrosis.jpg|left|thumb|400px|Old myocardial infarction with fibrosis.]]
| [[Image:AMI mural thrombus 1.jpg|left|thumb|400px|Myocardial Infarction: Gross; Left ventricle; a mural thrombus.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:AMI mural thrombus 2.jpg|left|thumb|400px|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.]]


[[Image:AMI with epicardial fibrin.jpg|left|thumb|400px|Acute myocardial infarction with epicardial fibrin.]]
| [[Image:AMI mural thrombus 3.jpg|left|thumb|400px|Myocardial Infarction: Gross; A ventricular slice near apex; Large old anterior and posterior transmural infarctions with mural thrombosis. ]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Posterior wall aneurysm.jpg|left|thumb|400px|Myocardial Infarction: Gross; External view showing indented area represent small posterior wall aneurysm. ]]


[[Image:Ruptured MI.jpg|left|thumb|400px|Myocardial infarction and rupture.]]
| [[Image:Anterior MI and aneurysm.jpg|left|thumb|400px|Myocardial Infarction: Gross; close-up view of anterior wall of left ventricle with dimpling due to aneurysm. Surrounding hyperemia indicates acute infarction.]]
|}


{| align="center"
!
|-valign="top"
| [[Image:Mural thrombus and healed MI.jpg|left|thumb|400px|Myocardial Infarction: Gross; healed lesion with mural thrombus (an excellent example)]]


[[Image:MI and DM.jpg|left|thumb|400px|Myocardial infarction; free wall, 6 days old, in a patient with [[diabetes mellitus]] and [[hypertension]].]]
| [[Image:Myocardial infarct scar.jpg|left|thumb|400px|Myocardial Infarct Scar: Gross; natural color; very large old anterior infarct with wall thinning, mild aneurysm and endocardial thickening. A typical lesion.]]  
 
|}
 
[[Image:MI and DM 2.jpg|left|thumb|400px|Myocardial infarction free wall, 6 days old, in a patient with [[diabetes mellitus]] and [[hypertension]].]]
 
 
[[Image:Anterior surface in APMI.jpg|left|thumb|400px|Anterior surface of the heart in patient with acute posterior myocardial infarction.]]
 
 
[[Image:Posterior surface of APMI.jpg|left|thumb|400px|Posterior surface of the heart in patient with acute posterior myocardial infarction.]]
 
 
[[Image:Old MI with aneurysm.jpg|left|thumb|400px|Old myocardial infarction with aneurysm formation]]
 
 
[[Image:AMI mural thrombus 1.jpg|left|thumb|400px|Myocardial Infarction: Gross; Left ventricle; a mural thrombus.]]
 
 
[[Image:AMI mural thrombus 2.jpg|left|thumb|400px|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.]]
 
 
[[Image:AMI mural thrombus 3.jpg|left|thumb|400px|Myocardial Infarction: Gross; A ventricular slice near apex; Large old anterior and posterior transmural infarctions with mural thrombosis. ]]
 
 
[[Image:Posterior wall aneurysm.jpg|left|thumb|400px|Myocardial Infarction: Gross; External view showing indented area represent small posterior wall aneurysm. ]]
 
 
[[Image:Anterior MI and aneurysm.jpg|left|thumb|400px|Myocardial Infarction: Gross; close-up view of anterior wall of left ventricle with dimpling due to aneurysm. Surrounding hyperemia indicates acute infarction.]]
 
 
[[Image:Mural thrombus and healed MI.jpg|left|thumb|400px|Myocardial Infarction: Gross; healed lesion with mural thrombus (an excellent example)]]
 
 
[[Image:Myocardial infarct scar.jpg|left|thumb|400px|Myocardial Infarct Scar: Gross; natural color; very large old anterior infarct with wall thinning, mild aneurysm and endocardial thickening. A typical lesion.]]
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Revision as of 23:01, 17 January 2013

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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]

Gross Pathological Findings

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

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.


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)


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