MI

 earliest change histologically seen with acute myocardial infarction in the first day is contraction
band necrosis. (1-2 days)
 about 3 to 4 days old. There is an extensive acute inflammatory cell infiltrate, and many
neutrophils are undergoing karyorrhexis. The serum troponin would be elevated.
 intermediate myocardial infarction of 1 to 2 weeks in age. many macrophages along with
numerous capillaries and little collagenization.
 At 3 to 4 weeks of age, decreasing cellularity along with more prominence of collagen. Note that
there are remaining normal red myocardial fibers. Cardiac biomarkers are not positive at this
stage and myocardial rupture is unlikely.
 about 2 months following the initial ischemic event, myocardium demonstrates pale fibrosis
with collagenization following healing of a myocardial infarction. There is minimal cellularity; a
few remaining viable red myocardial fibers are present. this collagenous scar is nonfunctional for
contraction and will diminish the ejection fraction. Such a scar will not rupture.
 One complication of a transmural myocardial infarction is rupture of the myocardium. This is
most likely to occur in the first week between 3 to 5 days following the initial event, when the
myocardium is the softest. hemopericardium can lead to tamponade

Endocarditis

Infective:

 Staphylococcus aureus, produce an "acute" bacterial endocarditis

Streptococcus viridans group produce a "subacute" bacterial endocarditis.
 Portions of the vegetation can break off and become septic emboli.

Non-infective

 small pink vegetation on the rightmost cusp margin represents the typical finding with non-
bacterial thrombotic endocarditis (or so-called "marantic endocarditis"). This is non-infective. It
tends to occur in persons with a hypercoagulable state (Trousseau's syndrome, a paraneoplastic
syndrome associated with malignancies) and in very ill persons.
 Marantic endocarditis friable and very prone to embolize.
 bland vegetation typical of the non-infective forms of endocarditis.. It appears pink because it is
composed of fibrin and platelets
 Libman-Sacks endocarditis flat, pale tan, spreading vegetations over the mitral valve surface
and even on the chordae tendinea seen in patient with systemic lupus erythematosus.
 small verrucous vegetations seen along the closure line of mitral valve are associated with acute
rheumatic fever. These warty vegetations average only a few millimeters and form along the line
of valve closure over areas of endocardial inflammation. Such verrucae are too small to cause
serious cardiac problems
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