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Teaching

Biomedical Sciences - PRINCIPLES OF DISEASE



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Week 7

Ischaemia 4

Created by Prof. Mike Dixon

Tissue: Heart - myocardium


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Diagnosis 1



Diagnosis 1
Acute myocardial infarction

This is because
The myocardium is necrotic and there is no evidence of organisation/repair. The appearances are consistent with onset about 5 days prior to death.

Comments on diagnosis 1
The myocardial softening consequent upon necrosis can precipitate acute cardiac failure or can lead to ventricular rupture and sudden death.


Key point 1



Much of the myocardium in the section is necrotic. Cell necrosis is shown by: (i) increased cytoplasmic eosinophilia - eosin is an acidic dye so staining is increased following exposure of basic amino groups on denatured proteins. (ii) loss of nuclei. Compare the dead fibres [yellow] with viable fibres [green arrow].


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Key point 2



Around the margins of the infarct there will be some ingress of acute inflammatory cells into the dead tissue. Here you can see a band of blue-stained cells (polymorphs) together with nuclear debris released from dead fibres. Polymorphs are drawn by the chemotactic effects of tissue breakdown products such as denatured proteins and released enzymes.


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Key point 3



In this area the infarcted myocardium has partly ruptured. There are dead fibres interspersed with small numbers of polymorphs and in the centre the fibres have disappeared to be replaced by areas of haemorrhage. The bluish areas could be pooled DNA or, possibly, precipitated calcium salts.


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