Myocardial Infarction

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					Myocardial Infarction

Jagdish Butany MBBS,MS,FRCPC.
  Prof Dept Lab Med &Pathobiol.
      Pathologist UHN/TGH
          416 340 3003
    jagdish.butany@uhn.on.ca
    Fac Pharmacy Nov 26 2007
               Objectives
• Understand the causes of Myocardial
  Infarction(MI)
• Understand the pathologic changes caused
  by the MI
• Appreciate the Basis and the Complications
  of a MI
• The role of important pharmacologic agents
    Myocardial Infarction

•Normal Myocardium
•CAD-Ischemia
•Myocardial Infarction
•Complications of M.I.
•Treatment of M.I.
            Atherosclerosis

Multifactorial Disease:
Risk Factors:
     Hypertension         Age
     Hyperlipidemia       Family history
     Diet                 Stress
     Cigarette smoking Genetics
   Acute Coronary Syndromes
• Acute Coronary Syndromes
Stable angina
Unstable angina
Other
• Acute Myocardial Infarction
• Sudden Death
    Myocardial Infarction

•Normal Myocardium
•CAD-Ischemia
•Myocardial Infarction
•Complications of M.I.
•Treatment of M.I.
    Ischemic Heart Disease

Epidemiology: 80% of cardiac mortality
           5 million Americans/year-CHF
       M I-Causes
Epicardial Coronary Artery
Pathology:
1. Atherosclerosis
2. Plaque changes
3. Thrombosis
(4. Non-atherosclerotic disease)
    Myocardial Infarction

•Normal Myocardium
•CAD-Ischemia
•Myocardial Infarction
•Complications of M.I.
•Treatment of M.I.
        ACUTE MYOCARDIAL
           INFARCTION
•   Death of heart muscle due to a prolonged
    reduction in the supply of oxygenated
    blood, relative to demand (i.e. ischemia),
    in the region served by an occluded
    coronary artery.
    ACUTE MYOCARDIAL
        INFACTION

Causes:
•Atherosclerotic Plaque
•Disrupted atherosclerotic plaque
•Plaque hemorrhage/thrombosis.
        MORPHOLOGY OF ACUTE
       MYOCARDIAL INFARCTION(1)
1. Microscopy:
  Early: • Cytoplasmic homogenisation
            • Hypereosinophilia
         • Nuclear changes
         • Wavy fibers
         • Infiltration by WBCs (12-18
            hours)
2. Gross (12-24 hrs):
         • Discoloration
         • Edema, softening
MYOCARDIAL INFARCTION-
    Healing Stages (2)

   •   Marked acute inflammation
   • Granulation tissue
   • Fibrosis
CORONARY ARTERY DISEASE:Significance of
                 degree of Stenosis
•   Severe stenosis
     • Occlusion
         Few clinical M.I.
• Mild stenosis
     • 50-60% or less Stenosis
         More acute M.I. infarcts

           Webster JACC; 15:218A; 1990
   Coronary Artery Disease

Plaque disruption :Inflamed Plaque
• Primary plaque fissure
• Primary plaque ulceration
• Rupture and hemorrhage
    Myocardial Infarction

•Normal Myocardium
•CAD-Ischemia
•Myocardial Infarction
•Complications of M.I.
•Treatment of M.I.
   COMPLICATIONS OF
ISCHEMIC HEART DISEASE
    Myocardial Infarction

•Normal Myocardium
•CAD-Ischemia
•Myocardial Infarction
•Complications of M.I.
•Treatment of M.I.
•Phamacologic agents
Treatment of coronary artery disease
1. Angioplasty
2. Angioplasty + stent
3. Angioplasty + stent + local therapy
4. CABG


Treatment of myocardial infarction
1. Thrombolytic therapy
2. Angioplasty
Complications of thrombolytic therapy
1. Contraindications for therapy
   • Bleeding
   • Previous CVA
   • Recent surgery/trauma
   • Hypotension
   • Active peptic ulcer


Possible complications
1. Stroke

2. Myocardial rupture
ThankYOU !!!

				
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posted:11/7/2011
language:English
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