Subendocardial ischemic myocardial lesions associated with severe coronary atherosclerosis.

摘要: Morphologic changes in the subendocardial myocardium that appeared to be caused by severe, chronic ischemia were studied patients with fatal ischemic heart disease admitted Specialized Center of Research for Ischemic Heart Disease at University Alabama Birmingham period 1970--1977. Thirteen selected this report on basis they had lesions we believe have been and no evidence acute or remote myocardial infarction other conditions may contributed their terminal illness death. Clinical findings unstable angina, congestive failure, usually increase plasma enzymes indicative damage, electrocardiographic consistent ischemia. All 13 75% greater stenosis three major coronary arteries; none thrombotic embolic artery occlusion. The left ventricle all cases was hypertrophied. showed circumferential pallor, hyperemia, focal fibrosis without perceptible loss volume papillary muscles trabeculae carneae. Microscopically, one two layers preserved myofibers adjacent endocardium, vacuolar change deeper fibers, areas coagulation necrosis variable size external fibers change. Coagulation extensive some not associated infiltration neutrophils. repair reaction involved removal necrotic sarcoplasm mononuclear phagocytes, resulting a reticular-appearing tissue stromal collapse. Granulation seen. Collagen deposited within area previous sarcolemmal sheaths. distribution morphology severe atherosclerosis are distinctive can distinguished from total occlusion artery.