Pathologic·Pathology·Heart (myocardium)

Acute MI — coagulative necrosis of cardiomyocytes

Stain: H&E·Magnification: 20x·Tissue: Infarcted cardiac muscle·4 labeled regions

Wikimedia Commons · File:Acute_myocardial_infarction_with_coagulative_necrosis_(4).JPG · https://commons.wikimedia.org/wiki/File:Acute_myocardial_infarction_with_coagulative_necrosis_(4).JPG (CC-licensed)

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Description

Day 1–3 MI: hypereosinophilic "ghost" myocytes with loss of nuclei + striations, wavy fibers, and neutrophilic infiltrate at the margins. Coagulative necrosis is the hallmark of ischemic injury everywhere except the brain (liquefactive).

Labeled regions (4)

1
Hypereosinophilic "ghost" myocytes
Intense pink cytoplasm without nuclei or visible striations. Architecture preserved but cells are dead (coagulative necrosis).
2
Loss of nuclei (karyolysis)
Nuclear fading reflects DNase activity — established within 24h of infarction.
3
Neutrophilic infiltrate
Days 1–3: neutrophils predominate at necrotic margins. Replaced by macrophages days 3–7 (most fragile period — rupture risk).
4
Adjacent viable myocardium
Pink myocytes retaining nuclei + striations. Surgical margin reference for transmural vs subendocardial infarction.