Ischemic heart disease
31 May 2023•0 j'aime•5 vues
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Santé & Médecine
a discussion on atherosclerosis and the events leading to myocardial infarction.
Tamil MahizhenthiSuivre
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Ischemic heart disease
- 1. PATHOGENESIS OF ISCHEMIC HEART DISEASE Dr Tamil Nila 2nd year postgraduate Department of Pathology
- 3. Risk Factors Non Modifiable Modifiable Others Genetic abnormalities Family history Increasing age Male gender Hyperlipidemia Hypertension Cigarette smoking Diabetes Inflammation Hyperhomocystenemia Metabolic syndrome Lipoprotein A
- 4. Pathogenesis of Atherosclerotic plaque
- 8. Pathogenesis • Progressive atherosclerotic narrowing of epicardial coronary arteries Chronic • Superimposed plaque change • Emboli • Vasospasm Acute
- 9. Chronic Vascular Occlusion •>70% occlusion •Critical Stenosis Exertional angina •>90% occlusion Angina at rest Collateral circulation
- 10. Acute Plaque change Stable Atherosclerotic plaque Unstable atherothrombotic lesion Rupture Superficial Erosion Ulceration Fissuring Deep hemorrhage
- 12. Angina Pectoris Stable Angina Prinzmetal variant Angina Unstable/ Crescendo angina Paroxysmal Recurrent Sub – sternal / Precordial Transient Insufficient to induce myocyte necrosis
- 13. Myocardial Infarction • Subendothelial collagen & necrotic plaque contents exposed to blood Atheromatous plaque rupture • Adhesion, Aggregation & activation • Thromboxane A2, ADP & Serotonin • Vasospasm Role of Platelets • Coagulation activated by tissue factor • Thrombus Grows in size Lumen occlusion
- 15. Reversible Vs Irreversible Injury
- 16. Key Events Feature Time Onset of ATP Depletion Seconds Loss of Contractility <2 minutes ATP reduced 50% of Normal 10% of Normal 10 minutes 40 minutes Irreversible cell Injury 20 – 40 minutes Microvascular Injury >1 hours
- 17. Troponins
- 18. Gross – Myocardial Infarction Histochemical Stain with triphenyltetrazolium chloride
- 19. Morphology at 0 – ½ hour • Reversible • No gross changes • No light microscopic changes • Electron microscopy • Relaxation of myofibrils • Glycogen loss • Mitochondrial swelling
- 20. Morphology ½ hr – 4 hrs • No gross change • Light microscopy • Waviness of fibres at borders • Electron microscopy • Sarcolemmal disruption • Mitochondrial amorphous densities
- 21. Morphology 4 – 12 hrs • Gross • Dark mottling • Light Microscopy • Early coagulative necrosis • Edema • hemorrhage
- 22. Morphology 12 – 24 hrs • Gross • Dark Mottling • Light Microscopy • Coagulative necrosis • Marginal Contraction band necrosis • Early neutrophilic infiltrate
- 23. Morphology 1 – 3 days • Gross • Mottling with yellow-tan infarct centre • Light Microscopy • Coagulative necrosis • Interstitial infiltrate of Neutrophils
- 24. Morphology 3 – 7 days • Gross • Hyperemic border • Central yellow – tan softening • Light Microscopy • Disintegration of dead myofibers • Early phagocytosis of dead cells
- 25. Morphology 7 – 10 days • Gross • Yellow tan • Soft • Depressed red tan margins • Light Microscopy • Phagocytosis • Granulation tissue formation
- 26. Morphology 10 – 14 days • Gross • Red gray depressed infarct borders • Light Microscopy • Granulation tissue • Collagen deposition
- 27. Morphology 2 – 8 weeks • Gross • Gray-white scar • Progressive from border toward core of infarct • Light Microscopy • Increased collagen • Decreased cellularity
- 28. Morphology >2 months • Gross • Scarring complete • Light Microscopy • Dense collagenous scar
- 29. Reperfusion
- 30. Risk of reperfusion • Mitochondrial Dysfunction • Myocyte hypercontracture • Free radicals • Leukocyte aggregation • Platelet and complement activation
- 31. Reperfusion - Microscopy • Contraction band necrosis • Intense eosinophilic bands of hypercontracted sarcomeres
- 32. Consequences and complication of Myocardial infarction • Contractile dysfunction • Papillary muscle dysfunction • Right ventricular infarction • Myocardial rupture • Arrhythmias
- 33. Consequences and complication of Myocardial infarction • Pericarditis • Chamber dilation • Mural thrombus • Ventricular aneurysm • Progressive heart failure
- 34. Chronic ischemic heart disease • Gross • Cardiomegaly • LV hypertrophy • Dilation • Stenotic Atherosclerosis • Scars/Infarcts • Microscopy • Myocardial hypertrophy • Diffuse subendocardial myocyte vacuolisation • Interstitial fibrosis
- 35. Summary
- 36. References • Robbins and Cotran pathologic basic of disease • Atlas of Forensic pathology, Peter M Cummins • Autopsy pathology – A manual and atlas, Andrew J Connolly
- 37. Thank you