Recommended
More Related Content
What's hot
What's hot (20)
Similar to Ischemic heart disease
Similar to Ischemic heart disease (20)
More from Tamil Mahizhenthi
More from Tamil Mahizhenthi (15)
Recently uploaded
Recently uploaded (20)
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