ST elevation myocardial infarction gross pathology

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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

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; 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

↑ 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)
↑ 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)
↑ 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)

External links

Template:WS Template:WikiDoc Sources

[pmid17951284-1] 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)

[pmid15339869-2] 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)

[pmid18071078-3] 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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v t e ST Elevation Myocardial Infarction
Background	Overview • Epidemiology and Demographics • Classification
Risk factors and Triggers	Risk Factors • Triggers
Pathophysiology	Pathophysiology of Vessel Occlusion • Pathophysiology of Reperfusion• Gross Pathology • Histopathology
Diagnosis	Diagnosis • Symptoms • Differential Diagnosis of Chest Pain • Physical Examination • Electrocardiogram • Right ventricular myocardial infarction • Atrial Infarction • Cardiac Markers • Coronary Angiography
Treatment	Pre-Hospital Care Pre-Hospital Care Initial Care Initial Care • Oxygen • Nitrates • Analgesics • Aspirin • Beta Blockers Pharmacologic Reperfusion • Reperfusion Therapy (Overview of Fibrinolysis and Primary PCI) • Fibrinolysis Mechanical Reperfusion • The Importance of Reducing Door-to-Balloon Times • Primary PCI • Adjunctive and Rescue PCI • Rescue PCI • Facilitated PCI • Adjunctive PCI • CABG • Management of Patients Who Were Not Reperfused • Assessing Success of Reperfusion Antithrombin Therapy • Antithrombin therapy • Unfractionated heparin • Low Molecular Weight Heparinoid Therapy • Direct Thrombin Inhibitor Therapy • Factor Xa Inhibition Antiplatelet Agents • Aspirin • Thienopyridine Therapy • Glycoprotein IIbIIIa Inhibition Inhibition of the Renin-Angiotensin-Aldosterone System • Inhibition of the Renin-Angiotensin-Aldosterone System Other Adjunctive Therapies • Magnesium Therapy • Glucose Control • Calcium Channel Blocker Therapy
Monitoring	Arrhythmia Monitoring
Complications	Complications
Discharge Care	Secondary Prevention • Cardiac Rehabilitation • Prognosis

ST elevation myocardial infarction gross pathology

Contents

Overview

Gross Pathological Findings

Sources

References

External links

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