This scientific article examines the key morphological changes occurring in coronary vessels and myocardial tissue during infarction, with a particular emphasis on the mechanisms of ischemic injury, the dynamics of necrotic processes, and microcirculatory responses. Myocardial infarction is one of the most studied, yet still incompletely understood, pathologies of the cardiovascular system, as the morphological presentation of the disease depends on numerous variables—the nature of atherosclerotic changes, the types of acute coronary thrombosis, the degree of collateral circulation, and the time of reperfusion. Analysis of vascular pathology reveals a complex cascade of structural abnormalities, including atheromatous intimal damage, rupture of the fibrous plaque cap, formation of a mural or occlusive thrombus, and endothelial spasm and dysfunction, which together lead to a critical reduction in coronary blood flow.

During ischemia, the myocardium undergoes successive stages of morphological remodeling—from reversible cardiomyocyte damage to coagulative necrosis, the development of an acute inflammatory response, the formation of granulation tissue, and late scarring. Microcirculatory disturbances play a significant role in the development of this morphological picture: stasis, sludge phenomenon, plasma impregnation of vascular walls, capillary rupture, and diapedetic hemorrhages. These processes intensify the zone of necrosis and determine the subsequent organization of damaged tissue. The article focuses on the relationship between the morphological state of the coronary vessels and the clinical manifestations of myocardial infarction, which is of fundamental importance for diagnosis, selection of treatment tactics, and prognosis. The presented material reflects a modern view of the pathogenetic mechanisms of infarction and can serve as a basis for further research in the field of cardiopathology.