The infarcts caused by the venous system usually present only in soft organs such as the lungs , the intestine, the ovaries , the testicles, legs, arms, etc., and stroke produced in the artery course occur in solid organ the heart, the kidneys, the vessel, the liver , etc.
In colloquial language, when the word “heart attack” is mentioned without mentioning which organ it refers to, it is understood that it is an acute myocardial infarction .
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- 1 Types of heart attacks
- 1 Cardioembolic infarction
- 2 Atherothrombotic infarction
- 3 Anemic infarction
- 4 Hemorrhagic infarction
- 5 Septic infarction
- 6 Venous infarction
- 2 Ages where the disease is more frequent
- 3 Sources
Types of heart attacks
Heart attacks can occur in any organ or muscle, but the most frequent occur:
- In the heart ( acute myocardial infarction ).
- In the brain (cerebrovascular infarction).
- In the intestine (mesenteric intestinal infarction).
- In the kidney (renal infarction).
The basis of the clinical diagnosis is the demonstration of a cardiac, transcardiac, embolus source, without evidence of another cause of stroke. When the source is transcardiac due to a right-left shunt, it is called a paradoxical embolism. Acute myocardial infarction, sinus disease, mural thrombus, myxoma, mitral stenosis, etc. can be observed. The most frequent cause is atrial fibrillation. Its clinical expression depends on the affected vessel. On CT there is a cortical infarction, mainly in the distribution of the middle or posterior cerebral artery; a hemorrhagic infarction (reported between 43 and 68%) or multiple cerebral infarcts that affect the cortex or cerebellum. High frequency of silent heart attacks. Early finding of a hyperdense portion of the middle cerebral artery. Hypertensive hemorrhagic areas within a hypodense area are observed by CT.
Associated with atherosclerosis, chronic hypertension, decreased elasticity, lipohyalinosis, and thrombosis . The atheroma plaque can narrow and produce stenosis with complete occlusion, with or without overlapping thrombosis. Its clinical translation corresponds to the brain area damaged by the occluded artery. In the first hours the TAC can be negative; at 12-48 hours (acute phase), a hypodense zone with poorly defined margins, with a peripheral base and central vertex, located in the affected vascular territory, with a slight effect of mass and blurring of the grooves, is observed.
Anemic infarcts occur in organs with arboreal (Terminal) irrigation. The heart, kidney and spleen belong to them. The infarction in these organs, however, presents a hemorrhagic appearance in the first 24 hours. This is due to the extravasation of blood contained in the vessels that become necrotic. From the second day on, as this blood is reabsorbed, the macroscopic characters typical of coagulation necrosis appear (Figure 3.13). It is therefore an initial and only temporary hemorrhagic component, which does not remove the anemic nature of these heart attacks, since blood does not continue to reach the compromised area. In the cerebral white matter, anemic infarction does not appear hemorrhagic even at the beginning because the vessels are few in number.
The general fact that explains the hemorrhagic nature of some heart attacks is that blood continues to reach the ischemic area, although in insufficient quantity to maintain the vitality of the tissues (Figure 3.14). The most frequent conditions in which this occurs are:
- Partial obstruction,
- Migration of a thrombotic embolus,
- Anastomotic (reticular) irrigation and
- Double circulation.
It is produced by an infected thrombotic embolism. The lesion consists in part of a heart attack, in part of a frequently purulent inflammation. Septic infarcts are usually multiple and small due to the tendency of the embolus to break down into small masses due to germs . Septic pulmonary infarction is less hemorrhagic than pure infarction and does not have passive hyperemia as a condition.
Thus it is called the hemorrhagic infiltration of an organ or a sector of it, produced by the abrupt blockage of the venous drainage. The compromised tissue breaks down, the cells show paratrophic abnormalities and then necrosis. The most frequent causes are venous thrombosis, as in the kidney and brain, and torsion of the vascular pedicle, as in the testis and uterine annexes. Torsion affects veins more than arteries. The name is improper since the injury is not caused primarily by ischemia but by venous hyperemia.
Ages where the disease is more frequent
Cardiovascular disease is more frequent in men over the age of 50, and its appearance is not exceptional after the age of 30. In women, it is predominant after the age of 60, but an increase in frequency is also currently observed between the ages of 40 and 50.