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Myocardial Infarction:

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Myocardial Infarction: Dr. Venkatesh M. Shashidhar ... Myocardial Infarction - Gross. Coronary Atherosclerosis. Coronary Atherosclerosis with Thrombosis ... – PowerPoint PPT presentation

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Title: Myocardial Infarction:


1
Myocardial Infarction
  • Dr. Venkatesh M. Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine.

2
Myocardial Infarction
Introduction
Microscopic Pictures
Ischemic Heart Disease
Complications
Pathogenesis
Conclusions
Gross Pictures
Atherosclerosis
3
Anatomy
4
Coronary Arteries
LCx LAD
  • Left Coronary A.
  • L.A.Descending
  • Left Circumflex
  • Right Coronary A.

5
Ischaemic 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.

6
Patterns of CHD
  • Angina Pectoris
  • Acute Myocardial Infarction
  • Sudden cardiac death

7
Pathogenesis
  • Obstruction to blood flow.
  • Atheroma, Thrombosis Embolism
  • Diminished coronary perfusion.
  • Ischemia Angina
  • Infarction Necrosis
  • Inflammation
  • Granulation tissue
  • Fibrous scarring.

8
Gross - 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

9
Myocardial Infarction - Gross
10
Coronary Atherosclerosis
11
Coronary Atherosclerosis with Thrombosis
12
Myocardial Infarction 1 wks.
13
Myocardial Infarction - CS
14
2wk - Myocardial Infarction - 3d
15
Normal Myocardium
16
MI 18-24 hr loss of nucleus, contaction bands,
coagulative necrosis.
17
MI 3-4 day Hemorrhage, inflammation.
18
MI 1-2w Granulation tissue
19
MI 2-4 W - Resorption, fibrosis
20
MI 4-6 W - Collagen Scar
21
Complications
  • 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

22
MI - Rupture
23
Laboratory 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

24
Congenital Heart Diseases
25
Congenital 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.

26
Atrial Septal Defect (ASD)
27
Patent 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.

28
Coarctation of Aorta - Infant
29
Aneurysms Varicose Veins
30
Aneurysms
  • Abnormal dilatation of blood vessel.
  • Fusiform, Saccular dissecting.
  • Atherosclerosis, Syphilitic congenital.
  • Berry aneurysms Base of brain.
  • Complications
  • Thrombosis
  • Embolism
  • Rupture

31
Berry Aneurysm
32
Varicose Veins
  • Abnormal diffuse dilatation of veins.
  • Lower limbs- common
  • Congenital or acquired
  • Pathogenesis
  • Damage to valves
  • Stagnation
  • Increased pressure ? dilatation.
  • Chronic ulcers.

33
Complications of Aneurysms
  • Thrombosis
  • Embolism
  • Rupture

34
Varicose Veins
35
Coarctation of Aorta
36
Thank You...
  • Dr. Venkatesh M. Shashidhar
  • Senior Lecturer in Pathology
  • Fiji School of Medicine.
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