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CARDIOVASCULAR PATHOLOGY

CARDIOVASCULAR PATHOLOGY. BY ADEEB UL HASSAN 3 RD YEAR MBBS BOLAN MEDICAL COLLEGE QUETTA. ACTUTE MYOCARIAL INFARCTION I TO 2 DAYS MICROSCOPIC VIEW.

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CARDIOVASCULAR PATHOLOGY

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  1. CARDIOVASCULAR PATHOLOGY BY ADEEB UL HASSAN3RD YEAR MBBS BOLAN MEDICAL COLLEGE QUETTA

  2. 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.

  3. 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.

  4. 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.

  5. 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

  6. 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

  7. 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.

  8. 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.

  9. 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.

  10. 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

  11. 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 non-contractile tissue that reduces stroke volume and strains the remaining myocardium. The stasis of blood in the aneurysm predisposes to mural thrombosis.

  12. 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.

  13. 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.

  14. THANK U VERY MUCH • BY • ADEEB UL HASSAN • 3RD YEAR MBBS • BOLAN MEDICAL COLLGEQUETTA

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