ISCHEMIC HEART DISEASE: PATHOLOGY AND AUTOPSY DIAGNOSIS
Keywords:
Myocardial Ischemia, Histochemical, methods, Staining techniquesAbstract
Ischemic Heart Disease [IHD] is a generic designation for a group of related syndromes resulting from myocardial ischemia. Autopsy diagnosis of acute lesion in heart, such as early myocardial infarct, can have profound medico legal implications. The basic, irreversible lesion of the myocardium in acute “coronary heart disease” is an ischemic coagulation necrosis of muscle fibers with subsequent polymorphonuclear leukocytic infiltration, granulation tissue, and scar formation. Only severe ischemia lasting at least 20 to 40 minutes causes irreversible injury and myocyte death; the predominant pattern is coagulation necrosis. With longer periods of ischemia, microvasculature injury ensues. Studies using high resolution microscope and electron microscope should be undertaken for detection of ischemic changes which are missed on routine microscopy. Various staining techniques like TTC (Triphenyl Tetrazolium Chloride), NBT (Nitro-blue tetrazolium), Masson’s trichrome, histochemical methods and Electron Microscopic Apoptotic changes can be used for detection of early ischemic changes.
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Kumar V, Abbas A, Fausto N. Robins Basic Pathology 7th edition. Philadelphia: Elsevier Inc; 2004; 571-87. 2. Knight B, Saukko P. Knights forensic pathology, 3rd edition. London: Edward Arnold Publishers Ltd; 2004; 492-502.
Davies M, Woolf N, Robertson W. Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi. British Heart Journal, 1976, 38; 659-664.
Bashe WJ, Baba N, Keller DM, Geer JC, Anthony JR. Pathology of atherosclerotic heart disease in sudden death. Supplement III to Circulation. 1975 Dec; 51-52(3):63-69.
Farb A, Tang AL, Burke A, Laura S et al. Frequency of active coronary lesions, inactive coronary lesions, and myocardial infarction. Circulation. 1995 Oct; 92(7): 1701-09.
Jie Ouyang et al. Utility of desmin and a Masson’s trichrome method to detect early acute myocardial infarction in autopsy tissues. Int J Clin Exp Pathol 2010; 3(1):98-105.
Ricardo H.B. et al. In Situ Apoptosis Assay for the Detection of Early Acute Myocardial Infarction. American Journal of Pathology; 1996; 149(3):821-829.
Rubin R, Strayer D, Rubin E, Shwarting R, Gorstein F. Rubin’s pathology, 4th edition. Maryland, USA: Williams and Wilkins; 2005; 541-58.
Baroldi G, Radice F, Schmid G, Leone A. Morphology of acute myocardial infarction in relation to coronary thrombosis. American Heart Journal. 1974 Jan; 879(1):65-75.
Reichenbach DD, Moss NS, Meyer E. Pathology of heart in sudden cardiac death, The American Journal of Cardiology. 1977 May 26; 39:865-72.
Rodriguez-calvo MS, Tourret MN, Concheiro L, Munoz J, Suarez-Penaranda J. Detection of apoptosis in Ischemic heart, usefulness in Diagnosis of early myocardial injury. American journal of Forensic Medicine and Pathology. 2001; 22(3): 278-84.
Toshinobu H, Morie S, Koshichiro H. Coronary thrombosis in pathogenesis of acute myocardial infarction Histopathological study of coronary arteries in 108 necropsied cases using serial section; British Heart Journal, 1978, 40, 153-161.
Bernard B, Guido M. Histopathology of Early Myocardial Infarcts: A New Approach. American Journal of Pathology; 1974 Feb, 74(2); 301-318.
Michael J. Pathological view of sudden Cardiac death. Br Heart J 1981; 45: 88-96.
Takeshi T et al. Post-ischemic myocardial fibrosis occurs independent of hemodynamic changes. Cardiovascular Research.2003; 59: 926–933.
