Title: Myocardial Infarction:
1Myocardial Infarction
- Dr. Venkatesh M. Shashidhar
- Senior Lecturer in Pathology
- Fiji School of Medicine.
2Myocardial Infarction
Introduction
Microscopic Pictures
Ischemic Heart Disease
Complications
Pathogenesis
Conclusions
Gross Pictures
Atherosclerosis
3Anatomy
4Coronary Arteries
LCx LAD
- Left Coronary A.
- L.A.Descending
- Left Circumflex
- Right Coronary A.
5Ischaemic Heart Disease
- Common Health problem.
- High Mortality Morbidity.
- Etiology common Atherosclerosis
- Two major types Angina MI.
- Risk factors
- Hypertension
- Hypercholesterolemia
- Diabetes
- Smoking, Life style, Diet, Genetic.
6Patterns of CHD
- Angina Pectoris
- Acute Myocardial Infarction
- Sudden cardiac death
7Pathogenesis
- Obstruction to blood flow.
- Atheroma, Thrombosis Embolism
- Diminished coronary perfusion.
- Ischemia Angina
- Infarction Necrosis
- Inflammation
- Granulation tissue
- Fibrous scarring.
8Gross - Morphology - Micro
- 1-18h none
- 24h Pale, edema
- 3-4D Hemorrhage
- 1-3W Thin, yellow
- 3-6W Tough white
- None
- Edema, inflammation
- Necrosis, granulation
- Granulation tissue
- Dense Fibrosis
9Myocardial Infarction - Gross
10Coronary Atherosclerosis
11Coronary Atherosclerosis with Thrombosis
12Myocardial Infarction 1 wks.
13Myocardial Infarction - CS
142wk - Myocardial Infarction - 3d
15Normal Myocardium
16MI 18-24 hr loss of nucleus, contaction bands,
coagulative necrosis.
17MI 3-4 day Hemorrhage, inflammation.
18MI 1-2w Granulation tissue
19MI 2-4 W - Resorption, fibrosis
20MI 4-6 W - Collagen Scar
21Complications
- Arrhythmias and conduction defects,
- Extension of infarction, or re-infarction
- Congestive heart failure (pul edema)
- Cardiogenic shock
- Pericarditis
- Mural thrombosis, - embolization
- Myocardial wall rupture, tamponade
- Papillary muscle rupture, Ventricular aneurysm
22MI - Rupture
23Laboratory Diagnosis
- Creatinine Kinase
- CK- Isoenzymes (Fractions)
- MM - Muscles cardiac Skeletal
- MB - exclusively in cardiac muscle.
- BB - Brain, Bowel Bladder
- Troponins - I T.
- LDH - 1-5 (1 - 2 flip)
- Myoglobin
24Congenital Heart Diseases
25Congenital Heart Diseases
- Left-to-Right shunts.
- Atrial Septal Defect (ASD)
- Ventricular Septal Defect (VSD)
- Patent Ductus Arteriosus (PDA)
- Right-to-Left shunts
- Transposition of Great Arteries
- Obstructions
- Coarctation of Aorta
- Others.
26Atrial Septal Defect (ASD)
27Patent Ductus Arteriosus (PDA)
- The ductus arteriosus, serves to shunt blood from
pulmonary artery to aorta during intrauterine
life. Persistence of ductus, which normally
closes soon after birth, results in left-to-right
shunt.
28Coarctation of Aorta - Infant
29Aneurysms Varicose Veins
30Aneurysms
- Abnormal dilatation of blood vessel.
- Fusiform, Saccular dissecting.
- Atherosclerosis, Syphilitic congenital.
- Berry aneurysms Base of brain.
- Complications
- Thrombosis
- Embolism
- Rupture
31Berry Aneurysm
32Varicose Veins
- Abnormal diffuse dilatation of veins.
- Lower limbs- common
- Congenital or acquired
- Pathogenesis
- Damage to valves
- Stagnation
- Increased pressure ? dilatation.
- Chronic ulcers.
33Complications of Aneurysms
- Thrombosis
- Embolism
- Rupture
34Varicose Veins
35Coarctation of Aorta
36Thank You...
- Dr. Venkatesh M. Shashidhar
- Senior Lecturer in Pathology
- Fiji School of Medicine.