– Acute manifestations
• Unstable angina
• Myocardial infarction
• Sudden cardiac death
Angina
•Arteries
–Right Coronary A - Inferior wall MI (posterior)
–Left Coronary A - Main artery - Massive anterolateral wall MI
•Left Anterior Descending A - Antero- septal MI
•Circumflex Coronary A - Lateral MI
Morphological changes
• Myocardial infarction induces acute inflammation, followed by
organization and scarring ( the end result is the conversion of the
infarcted area into a collagenous scar in 6-8 weeks)
Time Event Comment
0- 12 hrs No visible change Cardiac enzymes are raised
12- 24 hrs Area of pale infarct There is intercellular edema
24- 72 hrs Infarct becomes soft & pale Infracted area shows coagulative
necrosis & inflammatory infiltrate is
seen, mostly neutrophils &
macrophages
3- 10 days Infracted area shows yellow The red border was due to the
colored dead tissue granulation tissue
surrounded by a hyperemic
red border
Weeks- A white scar is seen at the Healing takes place by deposition of
months site of the infarct collagenous / fibrous tissue
Sudden cardiac death
• Sudden cardiac death (no warning
symptoms or death shortly after the onset of
symptoms)
• It is due to either
– Infarction- may be massive or may precipitate
fatal arrhythmias
– Arrhythmias- Usually ventricular fibrillation
Complications of MI- Immediate
1) Contractile dysfunction-healing of the infarction is
by fibrosis, which has poor contractility
2) Severe myocardial pump failure (cardiogenic
shock)- due to a massive infarction
3) Arrhythmia- abnormal patterns of rate and rhythm
of the cardiac contraction
4) Myocardial rupture- in the first week after the
infarct the infarcted area is weak and can rupture.
It may result in hemopericardium and cardiac
tamponade
5) Pericarditis- inflammation of the pericardium
Cardiac
rupture
Hemopericardium
Ventricular
aneurysm