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Post-MI Timeline

Discussion in 'Step I' started by Diggidy, May 13, 2014.

  1. Diggidy

    Diggidy 7+ Year Member

    Jan 20, 2009
    I would like to get some clarification on the timeline of events that occur after an MI.

    I just got a UWorld question (Q. id 41 for those interested) that I got wrong because of conflicting information in first aid.

    The question basically presents a man found dead in his apartment post-MI day 12. It then asks what microscopic features would you see on tissue biopsy.

    First aid generalizes that between 3-14 days you are going to be macrophage clearing of cellular debris and granulation tissue formation beginning along the perimeter of the infarct. Given that this guy dropped dead, I assumed he had a wall rupture, which is caused from macrophage induced weakening of the ventricular wall. The answer was instead that you should observe granulation tissue with re-vascularization.

    UWorld doesn't even address why this man died, just gives a timeline for events that is completely different from First Aids and other resources that I have.
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  3. GrabSlamBoot

    GrabSlamBoot 7+ Year Member

    Nov 28, 2010
    The way pathoma splits it up is that after the first week you will begin seeing granulation tissue and then after the first month you will see scar tissue form so the info in pathoma is consistent with Uworlds answer choice. If you have a copy take a look.
  4. Ionian

    Ionian 2+ Year Member

    Nov 22, 2013
    First aid clearly says, Macrophages/Granulation tissue, mere centimeters away from Free wall rupture (as you said) in the 3-14 day entry on page 288.

    You would have expected the Macrophage free wall rupture thing day day 5.

    I had gotten this right, but I thinks its a bad question, they say "12 days after his MI he is found dead in his apartment"

    So your saying, he literally died on day 12 and was found the same day? ....lucky.
    I wanted to assume he died of free wall rupture too, I think it makes more sense he died of that, just to be discovered later, but that's not the information I was given in the question stem, and I think if that were the case, the question writer would have to clarify.

    See 12 days, use 12 days.
    Last edited: May 13, 2014
  5. Ismet

    Ismet PGY-fun! Administrator Physician 5+ Year Member

    May 15, 2011
    The information in FA doesn't conflict, it's just not complete. Not much in FA is complete. Day 3-14 is a HUGE window, which starts out with macrophage infiltration and ends with granulation tissue. Day 12 is much, much closer to day 14, so you should assume that he was at the granulation tissue part. If they said Day 5 or 6 post-MI, then you'd go with the macrophage infiltration response.
  6. CherryRedDracul

    CherryRedDracul Resident Sh!tposter Physician 5+ Year Member

    Oct 12, 2012
    North America
    There's a lot of variability in the literature about when most free wall ruptures occur. Most will agree that the vast majority of them occur within a week. I go by the 3-7 days post-MI range for Step 1 purposes.

    I agree with Ionian that the question was too vague and leaves a lot up for interpretation. And yeah, First Aid keeps the timeline a little blurry perhaps because of the variability in the literature.
  7. Diggidy

    Diggidy 7+ Year Member

    Jan 20, 2009
    I'm chalking this up to a poor question then, and that they are basically baiting you to think he had a free wall rupture given the time frame.

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