Pathology of ischaemic heart disease

  • M. J. Davies
Part of the Current Status of Clinical Cardiology book series (CSOCC, volume 5)


Clinical interest in atheroma, as regards the heart, begins with the asymptomatic patient in whom there is sufficient intimal disease to allow angina, acute infarction or sudden death to occur. The prior detection of such individuals is, however, rarely possible other than they may, but not inevitably, be members of groups identified in epidemiological studies to have certain risk factors1.


Acute Myocardial Infarction Papillary Muscle Ischaemic Heart Disease Stable Angina Atheromatous Plaque 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Shaper, A.G., Pocock, S.J., Walker, M., Phillips, A.N., Whitehead, T.P. and MacFarlane, P. W. (1985). Risk factors for ischemic heart disease: the prospective phase of the British Regional Heart Study. J. Epidemiol, and Comm. Hlth, 39, 197–209CrossRefGoogle Scholar
  2. 2.
    Newman, W.P., Freeman, D.S., Voors, A.W., Gard, P.D., Sprinivasan, S.R., Cresanta, J.L., Williamson, G.D., Webber, L.S. and Berenson, G.S. (1986). Relation of serum lipoprotein levels and systolic blood pressure to early atherosclerosis: The Bogalusa Heart Study. N. Engl. J. Med., 314, 138–43PubMedCrossRefGoogle Scholar
  3. 3.
    Glueck, C.J. (1986). Pediatric primary prevention of atherosclerosis. N. Engl. J. Med., 314, 175–6PubMedCrossRefGoogle Scholar
  4. 4.
    McGill, H. C. (1968). The Geographic Pathology of Atherosclerosis. (Baltimore: Williams and Wilkins) pp. 1–193Google Scholar
  5. 5.
    Ross, R. (1986). The pathogenesis of atherosclerosis - An update. N. Engl. J. Med., 314, 488–99PubMedCrossRefGoogle Scholar
  6. 6.
    Woolf, N. (1982). Endothelial alterations and atherogenesis. In Pathology of Atherosclerosis. (London: Butterworth Scientific) pp. 261–78Google Scholar
  7. 7.
    Aqel, N.M., Ball, R.Y., Waldmann, H. and Mitchinson, M.J. (1984). Monocytic origin of foam cells in human atherosclerotic plaques. Atherosclerosis, 53, 265–71PubMedCrossRefGoogle Scholar
  8. 8.
    Mahley, R. W. (1985). Atherogenic lipoproteins and coronary artery disease: concepts derived from recent advances in cellular and molecular biology. Circulation, 72, 943–8PubMedCrossRefGoogle Scholar
  9. 9.
    Baranowski, A., Adams, C.W.M., Bayliss High, O.B. and Bowyer, D.E. (1982). Connective tissue responses to oxysterols. Atherosclerosis, 41, 255–66PubMedCrossRefGoogle Scholar
  10. 10.
    Fuster, V., Steele, P. M. and Chesebro, J. H. (1985). Role of platelets and thrombosis in coronary atherosclerotic disease and sudden death. J. Am. Coll. Cardiol., 5, 175–84CrossRefGoogle Scholar
  11. 11.
    Faggiotto, A., Ross, R. and Harker, L. (1984). Studies of hypercholesterolaemia in the non-human primate. I. Changes that lead to fatty streak formation. Arteriosclerosis, 4, 323–40PubMedCrossRefGoogle Scholar
  12. 12.
    Singh, R.N. (1984). Progression of coronary atherosclerosis. Clues to pathogenesis from serial coronary angiography. Br. Heart J., 52, 451–61PubMedCrossRefGoogle Scholar
  13. 13.
    Willerson, J. T., Campbell, W. B., Winniford, M. D. et al. (1984). Conversion from chronic to acute coronary artery disease: speculation regarding mechanisms. Am. J. Cardiol., 54, 1349–55PubMedCrossRefGoogle Scholar
  14. 14.
    Roberts, W. C. (1976). The coronary arteries and left ventricle in clinically isolated angina pectoris. Circulation, 54, 388–90PubMedGoogle Scholar
  15. 15.
    Roberts, W. C. (1979). The coronary arteries and left ventricle in clinically isolated angina pectoris - a necropsy analysis. Am. J. Med., 67, 792–9PubMedCrossRefGoogle Scholar
  16. 16.
    Thomas, A. C., Davies, M.J., Dilly, S., Dilly, N. and Franc, F. (1986). Potential errors in the estimation of coronary arterial stenosis from clinical arteriography with reference to the shape of the coronary arterial lumen. Br. Heart J., 55, 129–39PubMedCrossRefGoogle Scholar
  17. 17.
    Lichtlen, P.R., Rafflenbeul, W. and Freudenberg, H. (1985). Patho-anatomy and function of coronary obstructions leading to unstable angina pectoris - anatomical and angiographic studies. In Hugenholtz, P. G. and Goldman, B. S. (eds.), Unstable Angina, (Stuttgart: Schattauer) pp. 81–94Google Scholar
  18. 18.
    Brown, B.G. (1978). Coronary vasospasm. Observations linking the clinical spectrum of ischemic heart disease to the dynamic pathology of coronary atherosclerosis Arch. Intern. Med., 141, 716–22CrossRefGoogle Scholar
  19. 19.
    Brown, B.G., Bolson, E.L. and Dodge, H.T. (1984). Dynamic mechanisms in human coronary stenosis. Circulation, 70, 917–22PubMedCrossRefGoogle Scholar
  20. 20.
    Higgins, D., Santamore, W. P., Walinsky, P. and Nemir, P. (1985). Haemodynamics of human arterial stenosis. Int. J. Cardiol., 8, 177–92PubMedCrossRefGoogle Scholar
  21. 21.
    Freudenberg, H. and Lichtlen, P.R. (1981). Das nomale Wandsegment bei Koronartstemon, eine post mortale studie. Z. Kardiol., 70, 863–9PubMedGoogle Scholar
  22. 22.
    Saner, H. E., Gobel, F. L., Salomonowitz, E., Erlien, D. A. and Edwards, J. E. (1985). The disease free wall in coronary atherosclerosis: Its relation to degree of obstruction. J. Am. Coll. Cardiol., 6, 1096–99PubMedCrossRefGoogle Scholar
  23. 23.
    Quyyumi, A. A., Al-Rufaie, H. K., Olsen, E. G. J. and Fox, K. M. (1985). Coronary anatomy in patients with various manifestations of three vessel coronary artery disease. Br. Heart J., 54, 362–6PubMedCrossRefGoogle Scholar
  24. 24.
    Shea, M. J., Deanfield, J. E., Wilson, R., DeLandsheere, C., Jones, T. and Selwyn, A. P. (1985). Transient ischemia in angina pectoris: frequent silent events with everyday activities. Am. J. Cardiol., 56, 34E–38EPubMedCrossRefGoogle Scholar
  25. 25.
    Feldman, A.M. and Baughman, K.L. (1986). Myocardial infarction association with a myocardial bridge. Am. Heart J., 111, 784–7PubMedCrossRefGoogle Scholar
  26. 26.
    Cobb, L.A., Werner, J. A. and Trobaugh, G.B. (1980). Sudden cardiac death. A decade’s experience with out of hospital resuscitation. Mod. Concepts Cardiovasc Dis., 49, 31–6PubMedGoogle Scholar
  27. 27.
    DeWood, M. A., Spores, J. and Notske, R. et al. (1980). Prevalence of total coronary occlusion during the early hours of transmural myocardial infarction. N Enzl J Med., 303, 897–902CrossRefGoogle Scholar
  28. 28.
    Stadius, M.L., Maynard, C. and Fritz, J.K. et al. (1985). Coronary anatomy and left ventricular function in the first twelve hours of acute myocardial infarction: the Western Washington randomized intracoronary streptokinase trial. Circulation, 72, 292–301PubMedCrossRefGoogle Scholar
  29. 29.
    Bertrand, M.E., Lefebvre, J.M. and Laisne, C.L. et al. (1979). Coronary angiography in acute transmural myocardial infarction. Am. Heart J., 97, 61–69PubMedCrossRefGoogle Scholar
  30. 30.
    Ambrose, J. A., Winters, S. L. and Arora, R. R. et al. (1985). Coronary angiograph morphology in acute myocardial infarction: Link between the pathogenesis of unstable angina and myocardial infarction. J. Am. Coll. Cardiol., 6, 1233–8PubMedCrossRefGoogle Scholar
  31. 31.
    Chapman, I. (1984). The cause-effect relationship between recent coronary artery occlusion and acute myocardial infarction. Am. Heart J., 87, 267–71CrossRefGoogle Scholar
  32. 32.
    Davies, M.J., Woolf, N. and Robertson, W.B. (1976). Pathology of acute myocardial infarction with particular reference to occlusive coronary thrombi. Br. Heart J., 38, 659–64PubMedCrossRefGoogle Scholar
  33. 33.
    Ridolfi, R. L. and Hutchins, G. M. (1977). The relationship between coronary artery lesions and myocardial infarcts: ulceration of atherosclerotic plaques precipitating coronary thrombosis. Am. Heart J., 93, 468–86PubMedCrossRefGoogle Scholar
  34. 34.
    Chandler, A. B. (1974). Mechanisms and frequency of thrombosis in the coronary circulation. Thrombosis Res., 4, 3–23CrossRefGoogle Scholar
  35. 35.
    Davies, M. J. and Thomas, A. (1981). The pathological basis and microanatomy of occlusive thrombus formation in human coronary arteries. Philos. Trans. R. Soc. London (Biological), 294, 225–9CrossRefGoogle Scholar
  36. 36.
    Horie, T., Sekiguchi, M. and Hirosawa, K. (1978). Coronary thrombosis in pathogenesis of acute myocardial infarction. Histopathological study of coronary arteries in 108 necropsied cases. Br. Heart J., 40, 153–161PubMedCrossRefGoogle Scholar
  37. 37.
    Falk, E. (1983). Plaque rupture with severe pre-existing stenosis precipitating coronary thrombosis. Characteristics of coronary atherosclerotic plaques underlying fatal occlusive thrombi. Br. Heart J., 50, 127–34PubMedCrossRefGoogle Scholar
  38. 38.
    Constantinides, P. (1966). Plaque fissures in human coronary thrombosis. J. Atherosclerosis Res., 6, 1–17CrossRefGoogle Scholar
  39. 39.
    Davies, M.J. and Thomas, A. C. (1985). Plaque fissuring — the cause of acute myocardial infarction, sudden ischemic death and crescendo angina. Br. Heart J., 53, 363–73PubMedCrossRefGoogle Scholar
  40. 40.
    Erhardt, L. R., Unge, G. and Boman, G. (1976). Formation of coronary arterial thrombi in relation to onset of necrosis in acute myocardial infarction in man. Am. Heart J., 91, 592–8PubMedCrossRefGoogle Scholar
  41. 41.
    Henriksson, P., Edhag, O., Jansson, B. et al. (1985). A role for platelets in the process of infarct extension. N. Engl. J. Med., 313, 1660–1PubMedGoogle Scholar
  42. 42.
    Davies, M.J., Fulton, W.F.M. and Robertson, W.B. (1979). The relation of coronary thrombosis to ischemic myocardial necrosis. J. Pathol., 127, 99–110PubMedCrossRefGoogle Scholar
  43. 43.
    Maseri, A., Chierchia, S. and Davies, G. (1986). Pathophysiology of coronary occlusion in acute infarction. Circulation, 73, 233–9PubMedCrossRefGoogle Scholar
  44. 44.
    Levine, H.D. (1985). Subendocardial infarction in retrospect: pathologic, cardiographic and ancillary features. Circulation, 72, 790–800PubMedCrossRefGoogle Scholar
  45. 45.
    Spodick, D.H. (1983). Q wave infarction versus ST infarction. Non-specificity of electrocardiographic criteria for differentiating transmural and non-transmural infarction. Am. J. Cardiol., 51, 913–15PubMedCrossRefGoogle Scholar
  46. 46.
    Schulza, R.A., Pitt, B. and Griffith, L.S.C. et al. (1978). Coronary arteriography and left ventriculography in survivors of transmural and non-transmural myocardial infarction. Am. J. Med., 64, 108–13CrossRefGoogle Scholar
  47. 47.
    Hutler, A.M., Desanctis, R. W., Flynn, T. and Yeatman, L. A. (1981). Non-transmural myocardial infarction. A comparison of hospital and late clinical course of patients with that of matched patients with transmural anterior and inferior infarction. Am. J. Cardiol., 48, 591–601Google Scholar
  48. 48.
    Madigan, N.P., Rutherford, B.F. and Frye, R.L. (1976). The clinical course, early prognosis and coronary anatomy of subendocardial infarction. Am. J. Med., 60, 634–41PubMedCrossRefGoogle Scholar
  49. 49.
    Erhardt, L. R. (1974). Clinical and pathological observations in different types of acute myocardial infarction. A study of 84 patients deceased after treatment in coronary care unit. Acta Med. Scand. Suppl., 560, 1078Google Scholar
  50. 50.
    Roberts, W. C. and Jones, A. A. (1979). Quantitation of coronary arterial narrowing at necropsy in sudden coronary death. Analysis of 31 patients and comparison with 25 control subjects. Am. J. Cardiol., 44, 39–46PubMedCrossRefGoogle Scholar
  51. 51.
    Warnes, C. and Roberts, W. C. (1984). Comparison at necropsy by age group of amount and distribution of narrowing by atherosclerotic plaque in 2995 five mmlong segments of 240 major coronary arteries in 60 men aged 31–70 years with sudden coronary death. Am. Heart J., 108, 431–5PubMedCrossRefGoogle Scholar
  52. 52.
    Davies, M.J. (1981). Pathological view of sudden cardiac death. Br. Heart J., 45, 88–96PubMedCrossRefGoogle Scholar
  53. 53.
    Warnes, C.A. and Roberts, W.C. (1981). Sudden coronary death: comparison of patients with to those without coronary thrombus at necropsy. Am. J. Cardiol., 54, 1206–11CrossRefGoogle Scholar
  54. 54.
    Davies, M. J. and Thomas, A. (1981). Thrombosis and acute coronary artery lesions in sudden cardiac ischemic death. N. Engl. J. Med., 310, 1137–40CrossRefGoogle Scholar
  55. 55.
    Spain, D. M. and Bradess, V. A. (1981). Sudden death from coronary heart disease: survival time, frequency of thrombi and cigarette smoking. Chest, 58, 107–10CrossRefGoogle Scholar
  56. 56.
    Falk, E. (1985). Unstable angina with fatal outcome: dynamic coronary thrombosis leading to infarction and/or sudden death. Circulation, 71, 699–708PubMedCrossRefGoogle Scholar
  57. 57.
    Davies, M.J., Thomas, A. C., Knapman, P. A. and Hangartner. (1986). Intramyocardial platelet aggregation in unstable angina and sudden ischemic death. Circulation, 73, 418–27PubMedCrossRefGoogle Scholar
  58. 58.
    Ambrose, J A., Winters, S.L., Stern, A. et al. (1985). Angiographic morphology and the pathogenesis of unstable angina pectoris. J. Am. Coll. Cardiol., 5, 609–16PubMedCrossRefGoogle Scholar
  59. 59.
    Bresnahan, D. R., Davies, J. L., Holmes, D. R. and High, H. C. (1985). Angiographic occurrence and clinical correlates of intraluminal coronary artery thrombus: Role of unstable angina. J. Am. Coll. Cardiol., 6, 285–9PubMedCrossRefGoogle Scholar
  60. 60.
    Levin, D. C. and Fallon, J. T. (1986). Significance of the angiographic morphology of localised coronary stenoses. Histopathological correlates. Circulation, 66, 316–20CrossRefGoogle Scholar
  61. 61.
    Cairns, J. A. (1985). Aspirin, sulphaphrazone, or both in unstable angine - results of a Canadian multicenter trial. N. Engl. J. Med., 313, 1369–75PubMedCrossRefGoogle Scholar
  62. 62.
    Duguid, J.B. (1948). Thrombosis as a factor in the pathogenesis of aortic atherosclerosis. J. Pathol. Bacteriol., 60, 57–61PubMedCrossRefGoogle Scholar
  63. 63.
    Barger, A. C., Beeuwkes, R. Lainey, L.L. and Silverman, K.J. (1985). Hypothesis vasa vasorum and neovascularisation of human coronary arteries. A possible role in the pathophysiology of atherosclerosis. N. Engl. J. Med., 310, 363–73Google Scholar
  64. 64.
    Block, P. C. (1984). Mechanisms of transluminal angioplasty. Am. J. Cardiol., 53, 69–71CrossRefGoogle Scholar
  65. 65.
    Fishbein, M.C., Maclean, D. and Maroko, P.R. (1978). The histopathologic evolution of myocardial infarction. Chest, 73, 843–9PubMedCrossRefGoogle Scholar
  66. 66.
    Jennings, R.B., Reimer, K. A. (1981). Lethal myocardial ischemic injury. Am. J Pathol., 102, 241–55PubMedGoogle Scholar
  67. 67.
    Schuster, E.H. and Bulkley, B. H. (1980). Ischemia at a distance after acute Myocardial infarction. A cause of early post-infarction angina. Circulation, 62, 509–15PubMedGoogle Scholar
  68. 68.
    Page, D.L., Caulfield, J.B., Kastor, J.A., DeSanctis, R.W. and Sanders, C.A. (1971). Myocardial changes associated with cardiogenic shock. N. End J Med., 285, 133–7CrossRefGoogle Scholar
  69. 69.
    Alonzo, D.R Scheidt, S., Post, M. and KJillip, T. (1973). Pathophysiology of cardiogenic shock, quantification of myocardial necrosis, clinical pathologic and electrocardiographic correlations. Circulation, 48, 588–96Google Scholar
  70. 70.
    Gutovitz, A. L., Sobel, B. E. and Roberts, R. (1978). Progressive nature of myocardial injury in selected patients with cardiogenic shock. Am. J. Med., 41, 469Google Scholar
  71. 71.
    Schuster, E.H. and Bulkley, B.H. (1979). Expansion of transmural myocardial infarction: A pathophysiologic factor in cardiac rupture. Circulation, 60, 1532–8PubMedGoogle Scholar
  72. 72.
    Dellborg, M., Held, P., Swedberg, K. and Anders, V. (1985). Rupture of the myocardium - occurrence and risk factor. Br. Heart J., 54, 11–16PubMedCrossRefGoogle Scholar
  73. 73.
    Becker, A.E. and Vanmantgem, J. P. (1975). Cardiac tamponade - a study of 50 hearts. Eur. J. Cardiol., 3, 349–58PubMedGoogle Scholar
  74. 74.
    Vlodaver, Z., Edward, J.E. (1977). Rupture of ventricular septum or papillary muscle complicating myocardial infarction. Circulation, 55, 815–22PubMedGoogle Scholar
  75. 75.
    Sanders, C.A., Armstrong, P.W., Willerson, J.T. and Dinsmore, R.E. (1971).Aetiology and differential diagnosis of acute mitral regurgitation. Prog. Cardiovasc. Dis., 14, 129–52PubMedCrossRefGoogle Scholar
  76. 76.
    Nashimura, R. A., Schaff, H. V., Shub, C, Gersh, B. J., Edwards, W. D. and Takik, A.J. (1983). Papillary muscle rupture complicating acute myocardial infarction — analysis of 17 patients. Am. J. Cardiology, 51, 373–8CrossRefGoogle Scholar
  77. 77.
    Wei, J.Y., Hutchins, G.M.. and Bulkley, B.H. (1979). Papillary muscle rupture in fatal acute myocardial infarction: A potentially treatable form of cardiogenic shock. Ann. Intern. Med., 90, 149–53PubMedGoogle Scholar
  78. 78.
    Tibbutt, D. A. (1984). True left ventricular aneurysm. Br. Med. J., 289, 450–51CrossRefGoogle Scholar
  79. 79.
    Kulbertus, H.E., Rigo, P. and Legrand, V. (1985). Right ventricular infarction: pathophysiology diagnosis, clinical course and treatment. Mod. Concepts of Cardiovasc. Dis., 54, 1–5Google Scholar

Copyright information

© MTP Press Limited 1987

Authors and Affiliations

  • M. J. Davies

There are no affiliations available

Personalised recommendations