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Chapter 54 – ST-Segment Elevation Myocardial Infarction  :  Pathology, Pathophysiology, and Clinical Features

Elliott M. Antman

  CHANGING PATTERNS IN CLINICAL CARE, 1087
  IMPROVEMENTS IN OUTCOME, 1087
  Limitations of Current Therapy, 1087

  PATHOLOGY, 1088
  Plaque, 1090
  Heart Muscle, 1090

  PATHOPHYSIOLOGY, 1095
  Left Ventricular Function, 1095
  Ventricular Remodeling, 1097
  Pathophysiology of Other Organ Systems, 1098

  CLINICAL FEATURES, 1100
  Predisposing Factors, 1100
  History, 1100
  Physical Examination, 1101
  Laboratory Findings, 1102

  REFERENCES, 1109

The pathologic diagnosis of myocardial infarction (MI) requires evidence of myocyte cell death caused by prolonged ischemia. Characteristic findings include coagulation necrosis and contraction band necrosis, often with patchy areas of myocytolysis at the periphery of the infarct. During the acute phase of MI, most myocyte loss in the infarct zone occurs via coagulation necrosis and proceeds to inflammation, phagocytosis of necrotic myocytes, and repair eventuating in scar …