心血管系统（）.ppt

贫血性梗死的特点 ⑥ 病 变 1）肉 眼 （2）心 肌 梗 死 （myocardial infarction, MI） The tan to white areas of myocardial scarring seen from the endocardial surface here represent a remote healed myocardial infarction. There has been a previous extensive transmural myocardial infarction involving the free wall of the left ventricle. Note that the thickness of the myocardial wall is normal superiorly, but inferiorly is only a thin fibrous wall. The thinned area represents a ventricular aneurysm that has developed as a consequence of the healed infarct. Such an aneurysm represents non-contractile tissue that reduces stroke volume and strains the remaining myocardium. The stasis of blood in the aneurysm predisposes to mural thrombosis. The interventricular septum of the heart has been sectioned to reveal an extensive acute myocardial infarction. The dead muscle is tan-yellow with a surrounding hyperemic border This cross section reveals a large myocardial infarction involving the anterior left ventricular wall and septum. ⑥ 病 变 1）肉 眼 （2）心 肌 梗 死 （myocardial infarction, MI） 2）光 镜 凝固性坏死的特点 坏死区心肌细胞胞浆红染颗粒状，部分肌浆凝聚（↑），部分溶解，而呈现在一条肌纤维上深浅不一的特点。细胞核破碎消失。 大片状新鲜心肌梗死。除间质细胞外，心肌细胞不见细胞核结构 心肌梗死发生经过一定的时间（约6小时），反应的中性粒细胞浸润于坏死细胞之间。 大片胶原中掺杂着残存的少量心肌细胞。胶原束粗大，可见小血管和纤维细胞。 心脏破裂 3%-13% 4-7天多见 室壁瘤(Ventricular aneurysm) 10%-38% 愈合期多见 附壁血栓(Thrombosis) ●急性心包炎(Acute pericarditis) 15% 2-4天 临床并发症(Clinical complication) 心律失常75%-95%,休克10%-20%,左心衰60% ⑦合并症Complications （2）心 肌 梗 死 （myocardial infarction, MI） 梗死区破裂口 A cross section through the heart reveals a ventricular aneurysm with a very thin wall at the arrow. Note how the aneurysm bulges out. The stasis in this aneurysm allows mural thrombus, which is present here, to form within the aneurysm. 心包内积血 （3）心肌硬化 （myocardial fibrosis） ①定义：指广泛心肌纤维化 ②机理： ③影响： （4）冠状动脉性猝死 （sudden coronary death） 1）法医：排除自杀与他杀 2）病检：除冠状A和心肌病外