At 48 hours after a massive anterior myocardial infarction, the area of infarction shows coagulation necrosis with 'ghost outlines' of myocytes and a rim of neutrophilic infiltrate at the periphery. Which of the following complications is most likely to occur at this stage?

• A Dressler syndrome (autoimmune pericarditis)
• B Organization and scarring replacing the necrotic tissue
• C Formation of a ventricular aneurysm
• D Free wall rupture due to maximal neutrophilic enzymatic digestion ✓

Explanation

Free wall rupture and related mechanical complications (papillary muscle rupture, ventricular septal rupture) are most likely 3-7 days post-MI, when neutrophilic enzymatic digestion of necrotic myocytes is maximal, creating the weakest wall (the 'soft point'). At 48 hours, coagulation necrosis with neutrophil infiltration is present but not yet maximally destructive. Dressler syndrome occurs weeks later. Organization and scarring begin at 1-2 weeks. Ventricular aneurysm develops over months in a healed large infarct.

Reference: Robbins & Cotran Pathologic Basis of Disease, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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