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If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Please consult the latest official manual style Histologic dating of myocardial infarction you have any questions regarding the format accuracy. This chapter discusses the pathology of myocardial infarction MI and sudden death. Severe loss of myocardial contractility occurs within 60 seconds of the onset of ischemia; loss of viability irreversible injury takes at least minutes after total occlusion of blood flow.
MI has traditionally been viewed as a manifestation of necrotic cell death, but other forms of cardiomyocyte death have also been observed in reperfused MI; the extent to which the processes considered to comprise the spectrum of cell death—necrosis, apoptosis, autophagy, and necroptosis—each contribute to infarct size is currently unclear. Collateral circulation, preconditioning, and reperfusion can influence infarct size.
If ischemic myocardium is reperfused early, the degree of myocardial salvage greatly exceeds the damage associated with reperfusion injury. Myocardium may adapt to chronic ischemia by decreasing its contractility but preserving viability; this reversibly, dysfunctional tissue is commonly referred to as hibernating myocardium. Left ventricular remodeling begins within the first few hours after an MI and continues to progress, and the infarcted myocardium undergoes rapid turnover during the first weeks after MI.
MI also generates a systemic inflammatory response. Myocardial salvage occurs if reperfusion takes place within hours after onset of chest pain or electrocardiographic changes, and the infarct is likely to be subendocardial without transmural extension. MIs resulting from nonatherosclerotic diseases of the coronary arteries are rare.
In past decades, there have been several trends regarding the epidemiology and outcome of patients hospitalized with acute MI. Over the time span from topatients became ificantly older, were more likely to be women, and were more likely to receive effective cardiac medications. Despite a greater prevalence of comorbidities, hospital survival rates have globally improved over time. Your MyAccess profile is currently affiliated with '[InstitutionA]' and is in the process of switching affiliations to '[InstitutionB]'.
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Diagnosis of myocardial infarction at autopsy: AECVP reappraisal in the light of the current clinical classification