ST elevation myocardial infarction gross pathology: Difference between revisions

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__NOTOC__
{{ST elevation myocardial infarction}}
{{ST elevation myocardial infarction}}
{{CMG}}; '''Associate Editor-In-Chief:''' {{CZ}}
{{CMG}}; {{AE}} {{CZ}}


==Overview==
==Gross Pathology==
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 infarction 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>
 
<blockquote>
* Evolving phase of myocardial infarction: (>6 hours),  
* Evolving phase of myocardial infarction: (>6 hours),  
* Acute phase of myocardial infarction: (6 hours – 7 days),  
* Acute phase of myocardial infarction: (6 hours – 7 days),  
* Healing phase of myocardial infarction: (7–28 days),
* Healing phase of myocardial infarction: (7–28 days),
* Healed phase of myocardial infarction: (29 days and beyond).  
* Healed phase of myocardial infarction: (29 days and beyond).  
</blockquote>


<blockquote>
Time from Onset and Gross Morphologic Finding Relations:
'''Time from Onset and Gross Morphologic Finding Relations'''
* 18 - 24 hours: Pallor of [[myocardium]]  
* 18 - 24 hours: Pallor of myocardium   
* 24 - 72 hours: Pallor with some [[hyperemia]]  
* 24 - 72 hours: Pallor with some hyperemia   
* 3 - 7 days: [[Hyperemic flow|Hyperemic]] border with central yellowing   
* 3 - 7 days: Hyperemic border with central yellowing   
* 10 - 21 days: Maximally yellow and soft with [[vascular]] margins   
* 10 - 21 days: Maximally yellow and soft with vascular margins   
* 7 weeks: White [[fibrosis]]  
* 7 weeks: White fibrosis   
</blockquote>


==Gross Pathological Findings==
===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.]]
 
|}
 
[[Image:Image15533.jpg|left|thumb|400px|Myocardial infarction, fibrosis. Right Coronary Artery's territory.]]
 
 
[[Image:Image15973.jpg|left|thumb|400px|Acute Myocardial infarction; Posterior wall.]]
 
 
[[Image:Image917.JPG|left|thumb|400px|Gross example of myocardial infarction that is several weeks or perhaps months of age.]]
 
 
[[Image:Image919.JPG|left|thumb|400px|Acute myocardial infarction. Multi sliced view.]]
 
 
[[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:Old MI.jpg|left|thumb|400px|Old myocardial infarction with fibrosis and apical thrombus.]]
 
 
[[Image:Old MI with fibrosis.jpg|left|thumb|400px|Old myocardial infarction with fibrosis.]]
 
 
[[Image:AMI with epicardial fibrin.jpg|left|thumb|400px|Acute myocardial infarction with epicardial fibrin.]]
 
 
[[Image:Ruptured MI.jpg|left|thumb|400px|Myocardial infarction and rupture.]]
 
 
[[Image:MI and DM.jpg|left|thumb|400px|Myocardial infarction; free wall, 6 days old, in a patient with [[diabetes mellitus]] and [[hypertension]].]]
 
 
[[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.]]


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


[[Image:Posterior surface of APMI.jpg|left|thumb|400px|Posterior surface of the heart in patient with acute posterior myocardial infarction.]]
| [[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:Old MI with aneurysm.jpg|left|thumb|400px|Old myocardial infarction with aneurysm formation]]
| [[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:AMI mural thrombus 1.jpg|left|thumb|400px|Myocardial Infarction: Gross; Left ventricle; a mural thrombus.]]
| [[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: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: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: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: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:Posterior wall aneurysm.jpg|left|thumb|400px|Myocardial Infarction: Gross; External view showing indented area represent small posterior wall aneurysm. ]]
| [[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: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: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:Mural thrombus and healed MI.jpg|left|thumb|400px|Myocardial Infarction: Gross; healed lesion with mural thrombus (an excellent example)]]
| [[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: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: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.]]
<br clear="left"/>
|}


==Sources==
{| align="center"
*The 2004 ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction <ref name="pmid15339869">{{cite journal |author=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 |title=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) |journal=Circulation |volume=110 |issue=9 |pages=e82–292 |year=2004 |month=August |pmid=15339869 |doi= |url=http://circ.ahajournals.org/cgi/pmidlookup?view=long&pmid=15339869}}</ref>
!
|- valign="top"
| [[Image:Mural thrombus and healed MI.jpg|left|thumb|400px|Myocardial Infarction: Gross; healed lesion with mural thrombus (an excellent example)]]


*The 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients with ST-Elevation Myocardial Infarction <ref name="pmid18071078">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al'' |title=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 |journal=Circulation |volume=117 |issue=2 |pages=296–329 |year=2008 |month=January |pmid=18071078 |doi=10.1161/CIRCULATIONAHA.107.188209 |url=}}</ref>
| [[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.]]
|}  
<br clear="left" />


==References==
==References==
{{reflist}}
{{reflist|2}}
 
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==External links==
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* [http://www.themdtv.org The MD TV: Comments on Hot Topics, State of the Art Presentations in Cardiovascular Medicine, Expert Reviews on Cardiovascular Research]
* [http://www.clinicaltrialresults.org Clinical Trial Results: An up to dated resource of Cardiovascular Research]
* [http://hp2010.nhlbihin.net/atpiii/calculator.asp?usertype=pub Risk Assessment Tool for Estimating Your 10-year Risk of Having a Heart Attack - based on information of the Framingham Heart Study, from the United States National Heart, Lung and Blood Institute]
* [http://www.nlm.nih.gov/medlineplus/heartattack.html Heart Attack - overview of resources from [[MedlinePlus]].]
* [http://ww2.heartandstroke.ca/Page.asp?PageID=1975&ArticleID=5288 Heart Attack Warning Signals from the Heart and Stroke Foundation of Canada]
* [http://www.regionalpci-stemi.org/index.html Regional PCI for STEMI Resource Center - Evidence based online resource center for the development of regional PCI networks for acute STEMI]
* [http://www.stemisystems.org/ STEMI Systems - Articles, profiles, and reviews of the latest publications involved in STEMI care. Quarterly newsletter.]
* [http://d2b.acc.org/ American College of Cardiology (ACC) Door to Balloon (D2B) Initiative.]
* [http://www.americanheart.org/heartattack American Heart Association's Heart Attack web site - Information and resources for preventing, recognizing and treating heart attack.]
 
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Latest revision as of 00:17, 30 July 2020

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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:[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:

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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