Coronary atherosclerosis

Hemorrhage in atheromatous plaque

Recent thrombus on top of atherosclerosis

Thrombus on top of atherma

Coronary Arteries
Left Coronary A. L.A.Descending Left Circumflex Right Coronary A.
Right Coronary A
Left Circumflex

LCx

LAD

Rt. V

Lt. V

L.A. Descending A

Recent transmural myocardial infarct

Subendocardial infarction

Subendocardial infarct then becomes transmural extension

ME

NE

Necrosis

12-24 hours

Ill defined area of slight pallor

Inflammation

1-3 days

Pale infarct surrounded by a definite red (hyperemic) margin

Demolition

4-7 days

yellow softened infarct with a definite red margin.

Ingrowth of Granulation tissue

1-2 weeks

Progressive replacement of yellow infarct by red purple (granulation) tissue.

Maturation
cross linking - Remodeling -Capillary resorption
-Collagen

weeks & months

Gray white infarct

NORMAL MYOCARDIUM Central nuclei

RECENT MYOCARDIAL INFARCT

Inflammatory infiltrate rich in PNL (1-3 days)

GT in myocadial infarct (1-2 week)

Healed infarct (Months)

Healed infarct, white endocardial surface indicating myocardial scarring

Rt ventricle

MI- Microscopic features

One-day-old infarct
Up to 3 days duration

coagulative necrosis

Neutrophilic infiltrate

1 -2 weeks

>3 weeks

Granulation tissue

Scar

Myocardial infarct- Types

Transmural
Full thickness

Sub-endocardial
Inner 1/3 to half of ventricular wall Decreased circulating blood volume( shock, Hypotension, Lysed thrombus)

Superimposed thrombus in atherosclerosis

Focal damage

Circumferential

Transmural infarct

Subendocardial infarct

Mural thrombus over myocardial infarct

Mural Thrombus

Mural thrombus over myocardial infarct

Thrombus

Recent infarct

HEMOPERICARDIUM

HEMOPERICARDIUM, CARDIAC TAMPONADE

Site of rupture (day 3-5)

Papillary muscle rupture

Healed Infarct

Normal wall thickness

Thinned wall

Myocardial aneurysm

Aneurysm

Myocardial aneurysm

HEALED INFARCT AND APICAL ANEURYSM