Atherosclerosis of Right Coronary Artery, with Recent Intra-mural Plaque Rupture

Slide Heart Path #1

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Atherosclerosis of right coronary artery, with recent intra-mural plaque rupture.
This section is from the postmortem heart specimen of a 36 year old man who had undergone a left internal mammary artery -to-left anterior descending coronary artery bypass (CABG) two weeks before his death. Following the bypass, he was re-admitted two weeks later complaining of dyspnea on exertion and intermittent left shoulder pain. Evidence of continued cardiac dysfunction proceeded during his several day admission, with prolonged hypotension and anuric acute renal failure. At autopsy the heart showed myocardial infarcts of various microscopic ages and severe atherosclerosis of right and left coronary arteries. This section shows the right ventricular muscle and right coronary artery.

Question

1. Given the clinical information, which risks for atherosclerosis would you suspect might be present in this patient?
2. Which layer of the coronary artery seen in cross-section is most severely affected?
   What changes are present in this layer?
3. In light of the microscopic lesion in this coronary, what major complication might occur in such a coronary artery?
4. In looking at the slide and the entire wall of the heart muscle itself, which portion of the muscle (endocardium-myocardium-epicardium) shows the most severe changes (and what are the changes)?