Describe the gross and light microscopic changes evolved over two weeks duration in myocardial infarction. Add a note on the role of serum cardiac biomarkers in the diagnosis of myocardial infarction.
Gross and Microscopic Changes in Myocardial Infarction (MI) Over Two Weeks:
0–4 hours: No gross changes; microscopically, wavy fibers and early edema.
4–12 hours: Occasional pallor; early coagulative necrosis, edema, and hemorrhage microscopically.
12–24 hours: Red-blue mottling; more prominent coagulative necrosis with beginning neutrophil infiltration.
1–3 days: Yellow-tan infarct center; intense neutrophilic infiltrate and extensive necrosis.
3–7 days: Yellow-tan center with red-purple margins; macrophages remove dead myofibers, early granulation at margins.
1–2 weeks: Red-gray depressed borders; well-developed granulation tissue with neovascularization and collagen deposition.
~2 weeks: Pale, firm, depressed scar begins; increasing collagen, fewer inflammatory cells.
Role of Serum Cardiac Biomarkers:
Cardiac troponins (cTnI, cTnT) are highly sensitive and specific, rising 3–12 hours after MI, peaking at 24–48 hours, and remaining elevated 5–14 days. CK-MB rises 3–8 hours, peaks at 12–24 hours, and normalizes in 2–3 days, useful for detecting reinfarction. Myoglobin rises early but is non-specific. Biomarkers confirm MI diagnosis and guide management.
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