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Organizing myocardial infarct (251)
Causes of infarction coronary artery occlusion caused by change
in themorphology of atheromatous plaque: intraplaque hemorrhage
lceration fissuring
Occlusi!e thrombosis 1" hours #isible gross changes $ocation of
infarct:
left circumfle% lateral &all of left !entricle (e%cept ape%)
$eft anterior descending anterior &all of left !entricle near
ape%'
anterior !entricular septum right coronary inferiorposterior
left !entricle' posterior !entricular
septum macroscopy
Old infarct fibrosis &hite acute infarct dar yello&
mottling
2nd &ee Collagen fibers deposit* scar formation begins
areas of: normal tissue granulation tissue fibroblasts
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+nterstitial myocarditis (255)
in!ol!es the &holemyocardium* unlie infarct
&hich only in!ol!es a part ofit
causes !iruses co%aci*echo* influenza* ,+#*ricetsia* to%ins
often asymptomatic arrhythmias* sudden cardiac
death
-ense lymphocyticinflammation.
/ragmented fibers* partiallynecrotic.
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0heumatic myocarditis (21)
+mmune reaction antigenantibody mediated inflammatory disease
treptococcal infection group 3 laryngitis* pharyngitis (in!ol!ement
of
myocardium after 4 &ees) Cross reaction bet&een
streptococcis protein 6 and glycoprotein in the
heart* 7oints and other tissues. 8as more common &hen
streptococcal infections &ere common pper respiratory infection
can be complicated by cardiac disease
(0heumatic fe!er) 3rthritis de!elops* but milder
3schoff bodies mall granulomas surrounding blood
!essels(accumulation of cells around !essel) &ith time
completely obliterate !essel. -e!elop foci of necrosis.
3schoff bodies $ymphocytic infiltration*
plasma cells* focis ofs&ollen eosinophiliccollagen*
macrophages*giant cells
3nitscho& cells enlarged macrophagescharacteristic for
0/
#essel9
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0heumatic myocarditis (21) (page 2)
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0heumatic endocarditis (254)
+n!ol!ement of endocardium andleftsided !al!es
-amage of endothelium promotefibrinoid necrosis formation of
thrombiemboli
;eri!ascular region. +nflammatioconcentrate near !al!e.
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remic cardiomyopathy (2=>)
remia in chronic renal failure /ailure of renal e%cretory
function* metabolic and endocrine alteration in
renal damage /ibrinous or serofibrinous pericarditis (fibrin
layer on surface of pericardium) Cardiomyopathy $eads to
enlargement of cardiomyocardium
+f &ithout no&n cause primary some causes of disease:
uremia* alcoholic
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Bndocardial fibroelastosis (=)
6ost common during first 2 years of life Congenital disorder.
/ocal or diffuse
/ocal may ha!e no functional importance -iffuse may cause rapid
and progressi!e decompensation and death
;rogressi!e disease. /ocal disease sometimes not important.
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Duberculous pericarditis (25")
;ericarditis +nfectious: !iral* pyogenic bacteria* tuberculosis
+mmunologically mediated: 0/* $B* scleroderma* -ressler syndrome
6iscellaneous: myocardial infarction* uremia* neoplasia* trauma*
radiation*
surgery
3cute or chronicChronic pericarditis fibrous (not
fibrinous):
adhesi!e: minor fibrous adhesions in pericardial sac
constricti!e: dense fibrous response that compresses the heart and
restricts
inflo& ;re!ious radiation therapy* cardiac surgery*
tuberculosis Dhe pericardial space is obliterated by rigid mass of
fibrous tissue &ith deposits
of calcium focally
mall heart &ith restriction of !enous flo& into the
heart &ith abnormalcontraction
Eranulomas:
Caseous necrosisBpithelioid cells$anghans cells6acrophages
$anghans cells
+nflammatory infiltrate
tuberclous pericarditis 6ycobacterium tuberculosis
infection -irect spread from tuberculous
focis &ithin tracheobronchialnodes
Eranulomas in pericardium Bpithelioid cells* caseus necros
$anghans cells /ibrinous superficial inflammatiurface of
epicardium (not !isible)co!ered by fibrinous e%udate
andinflammatory infiltrate
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;ericardial metastases (squamous cell carcinoma of the lung)
(2>?)
6etastatic tumors occur in 5F o
patients dying of cancers /oci in pericardium /luid &ithin
pericardial sac 6etastases from breast* E+*
lungs* lymphomas* leuemias*melanoma
squamous cell carcinomacharacteristics: eratin pearls*
eratinization*
intracellular bridges
;rimary tumors of the heart israre. 6ost common primary
tumor
my%oma (benign tumor* treatesurgically).
6alignant usually metastasis(usually from lung or breast)
