Cardiovascular Pathology ICase 1

• 55-year old man with crushing chest pain radiating to the left shoulder

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Acute Myocardial infarction of left ventricleThe mixture of pale myocardium (thin arrow) and hemorrhage (thick arrow) highlight the infarcted tissue. The asterix points out the non-infarcted myocardium.

A. Right VentricleB. Left VentricleC. Anterior surface

4x objective

4x objective

myocardium

Acute inflammationCongested capillaries

neutrophils

Necrotic myocytes have lost nucei and cross-striations

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Acute Myocardial infarction of the anterior left ventricle and septum is delineated by an area of dark, red-brown hemorrhage

P = posterior

Heart has been fixed in formalin

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Acute Myocardial infarctionCross section of the left ventricle shows an extensive, circumferential acute myocardial infarction. The asterix points out the non-infarcted myocardium.

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Healed myocardial InfarctionCross section of the Heart (two halves):    

A. Right Ventricle      B. Left Ventricle.Arrows point to healed myocardial infarction.

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Myocardial Infarction extending to the papillary muscle

The arrow points to a partial rupture of the muscle. Asterix denotes mitral valve leaflet.

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Myocardial ruptureLongitudinal section of the heart.

The thick arrow points to the site of rupture of the apex of the left ventricle. The rupture occured secondary to an acute transmural infarction.The thin arrows outline the pericardial sac which is filled with blood

A. Left atrium  B. Mitral valve   C. Left ventricle

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Large Apical Ventricular aneurysm“C” represents the inlet to the aneurysm which contains a laminated thrombus (*). Notice the thin fibrotic wall (arrow) of the aneurysm.

A. Left atrium B. Left ventricle

Longitudinal section of the heart

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Ventricular aneurysmLongitudinal section of the heart through the (A ) Aortic valve  (B) Left ventricle (half of the left ventritricle is folded back (*)(C) Arrows delineate the thin, fibrotic wall of the aneurysm, which contains red thrombus

Identify the organ, structuresDescribe the gross morphologic changesDiagnosis?

Acute coronary artery thrombosisThe artery is "bread loaved" (cut in serial section)

Thrombus

Intimalhyperplasia

mediacalcifications

RECENT THROMBUS of CORONARY ARTERY