Workshop nr 15

Morphopathology

Ischemic cardiopathy
. Ischemic cardiopathy
Generic name of myocardial lesions caused by acute or chronic coronary
circulatorv disturbances

. Clinicalclassification:
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. Sudden cardiac death
Chronic ischemic cardiopathy:
. Ischemic myocardial fibrosis to + I - stable pectoris angina
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Ischemic cardiopathy morphology
. Acute:
Recent myocardial infarct
Myocardial infarction in course of connective organization
Myocardial infarct complicated with pericarditis
. Chronic:
Ischemic myocardial fibrosis

I. ACUTE MYOCARDIAL INFARCT

. Circumscribed area of ischemic necrosis (> 2.5 cm2) due to sudden suppression
of coronary circulation (acute ischemia)

l. Recent myocardial infarct (12-24 hours)

Area of ischemic necrosis;
. Area of structured coagulation necrosis
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. preseryed cell limits
Intermyocitic red blood cells;

2. Myocardial infarct at24-72 hours

Area of ischemic necrosis:
. Area of coagulation necrosis
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. preserved cell limits

Intermyocitic infl ammatory cell s;
 3. Myocardial infarction in course of connective organization
Area of remaining ischemic necrosisl
o Necrotic myocardial fibers
i. intense eosinophilic
ii. without nuclei and striations
iii. preserved cell limits
. They are degraded by neutrophilic enzymes and resorbed by macrophages
Necrotic area is surrounded by vascular granulation tissue
o The connective-vascular tissue of neoformation will replace step by step
(slowly) the necrotic area (through connective organization)
i. Capillaries of neoformation
ii. Immature connective tissue
iii. Inflammatory cells
4. Myocardial infarct complicated with pericarditis
Fibrinous pericarditis is a complication of the transmural myocardial infarction.
r Transmural myocardial infarction
o On pericardial surface:
i. fibrin exudate composed by eosinophilic fibrin network containing
a reduced number of neutrophiles.
. The underlying/ subjacent epicardium contains
i. acute vascular congestion and neutrophilic infiltrate
II. CHRONIC ISCHEMIC CARDIOPATIIY: Ischemic myocardial fibrosis

Ischemic myocardial fibrosis represents the morphological substrate of chronic

myocardial ischemia, caused by stenosing coronary atesclorosis ) \cardiomyocitic
atrophy and interstitial fibrosis
. normal myocardial areas, athrophied or compensatory hipertrofied
. diffirse interstitial fibrosis separating individual myocardial fibers
. small areas of fibrous scar that correspond to areas of old myocardial infarct,
connective orsanized