Myocardial infarction complications may occur immediately following a myocardial infarction (heart attack) (in the acute phase), or may need time to develop (a chronic problem). After an infarction, an obvious complication is a second infarction, which may occur in the domain of another atherosclerotic coronary artery, or in the same zone if there are any live cells left in the infarct.
Post-myocardial complications occur after a period of ischemia, these changes can be seen in gross tissue changes and microscopic changes.[1] Necrosis begins after 20 minutes of an infarction. Under 4 hours of ischemia, there are no gross or microscopic changes noted.[2]
From 4-24 hours coagulative necrosis begins to be seen, which is characterized by the removal of dead cardiomyocytes through heterolysis and the nucleus through karyorrhexis, karyolysis, and pyknosis.[3] On gross examination, coagulative necrosis shows darkened discoloration of the infarcted tissue. The most common complication during this period is arrhythmias.
Day 1-7 is marked by the inflammatory phase. Days 1-3 are marked by “acute inflammation”, in which neutrophils infiltrate the ischemic tissue. A major complication during this period is fibrinous pericarditis, particularly in transmural ventricular wall damage (an infarct that impacted all 3 layers of the heart, the epicardium, myocardium, and endocardium). This leads to inflammation, such as swelling, leading to rubbing of the heart on the pericardium. Day 4 through 7 are marked by “chronic inflammation”, on histology macrophages will be seen infiltrating the tissue. The role of these macrophages is the removal of necrotic myocytes. However, these cells are directly involved in the weakening of the tissue, leading to complications such as a ventricular free wall rupture, intraventricular septum rupture, or a papillary muscle rupture. At a gross anatomical level, this staged is marked by a yellow pallor.
Weeks 1-3 are marked on histology by abundant capillaries, and fibroblast infiltration. Fibroblasts start replacing the lost cardiomyocytes with collagen type 1 and leads to the granulation of tissue.
After several weeks fibrosis occurs and heavy collagen formation. Collagen is not as strong or compliant as the myocardium that it replaced, this instability could lead to a ventricular aneurysm, and the stasis of blood in an aneurysm can lead to a mural thrombus. A rarer complication that also occurs during this time is Dressler's syndrome and is thought to have autoimmune origins.[4]
^Muscle Tissue. In: Mescher AL. eds. Junqueira’s Basic Histology: Text and Atlas, 15e New York, NY: McGraw-Hill
^Kumar, V., Abbas, A. K., & Aster, J. C. (2015). Robbins and Cotran pathologic basis of disease (Ninth edition.). Philadelphia, PA: Elsevier/Saunders.
^Adigun, Rotimi; Bhimji, Steve S. (2018), "Necrosis, Cell (Liquefactive, Coagulative, Caseous, Fat, Fibrinoid, and Gangrenous)", StatPearls, StatPearls Publishing, PMID 28613685, retrieved 2018-11-03
^ Leonard S. Lilly. Pathophysiology Of Heart Disease : a Collaborative Project of Medical Students and Faculty. Philadelphia :Lippincott Williams & Wilkins, 2003.
and 27 Related for: Myocardial infarction complications information
Myocardialinfarctioncomplications may occur immediately following a myocardialinfarction (heart attack) (in the acute phase), or may need time to develop...
diagnose a myocardialinfarction based on anatomopathological findings. A chest radiograph and routine blood tests may indicate complications or precipitating...
A myocardialinfarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops in one of the coronary arteries of the heart...
than an external force (e.g., cocaine vasoconstriction leading to myocardialinfarction). Hypertension and atherosclerosis are risk factors for both atherosclerotic...
blood flow within the heart, leading to heart tissue damage, or a myocardialinfarction, also known as a heart attack. Coronary thrombosis is most commonly...
cardiovascular diseases. Types include stable angina, unstable angina, and myocardialinfarction. A common symptom is chest pain or discomfort which may travel into...
last decade, similar to myocardialinfarction treatment, thrombolytic drugs were introduced in the therapy of cerebral infarction. The use of intravenous...
diabetic patients. These complications can be divided into two types: acute and chronic. Acute complications are complications that develop rapidly and...
classifies cases upon presentation to either ST segment elevation myocardialinfarction (STEMI) or non-ST elevation acute coronary syndrome (NST-ACS); the...
through or around, blocked arteries, typically after a heart attack (myocardialinfarction (MI)). Reperfusion therapy includes drugs and surgery. The drugs...
contrast, brain tissue (in cerebral infarction) does not store glycogen, and the heart (in myocardialinfarction) is so specialized on aerobic metabolism...
future myocardialinfarction or need for other interventions. PCI is widely practiced and has a number of risks; however, major procedural complications are...
management, these diseases can progress into life-threatening complications of myocardialinfarction, gangrene, ischemic stroke, and in severe cases, terminate...
to the pain of myocardialinfarction (heart attack), pericarditis can be misdiagnosed as a heart attack. Acute myocardialinfarction can also cause pericarditis...
initiated a phase III clinical study of reperfusion injury in 1000 myocardialinfarction patients in centers throughout Europe. Results of that study were...
heartbeat. The duration of problems can vary from hours to months. Complications may include heart failure due to dilated cardiomyopathy or cardiac arrest...
resulting in a significant risk of death or disability due to myocardialinfarction. If treated quickly, this risk can be mostly avoided and the course...
breath and associated electrocardiogram (ECG) changes mimicking a myocardialinfarction of the anterior wall. During the course of evaluation of the patient...
oxygen deprivation to the heart or the risk of a heart attack (myocardialinfarction). Some people may experience severe pain even though there is little...
tachycardia), Inadequate coronary artery blood flow (such as myocardial ischemia and myocardialinfarction), and electrolyte disturbances, such as hypokalemia...
when there are mechanical complications of an infarction (ventricular septal defect, papillary muscle rupture or myocardial rupture). There are no absolute...
heartbeats, or bradycardia (for example, from drug overdose or myocardialinfarction). A permanent pacemaker may be placed in situations where the bradycardia...
is involved more commonly than the left coronary artery. If the myocardialinfarction is treated with thrombolytic therapy, the mortality increases to...
such as troponin levels): ST elevation myocardialinfarction (STEMI), non-ST elevation myocardialinfarction (NSTEMI), or unstable angina. STEMI is characterised...
linked to carotid artery thickening and increased risk of acute myocardialinfarction. Existing cardiovascular disease or a previous cardiovascular event...
Global Information