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动脉粥样硬化的血管通常是狭窄的,尸检时发现,心肌梗塞病人的冠状动脉比对照组要狭窄。这种狭窄的形成主要是内膜脂类沉积和纤维化的结果,但在血管中层经常显示出病灶性瘢痕形成,甚至还有弹性组织或肌肉组织的同中心萎缩。如主动脉一样,冠状动脉在一生中常呈进行性扩大,但是否这是一种自然老化过程或是一种心脏肥大反应仍有争议。在理论上,冠状动脉扩大到适当的程度应有利于逆转动脉粥样硬化闭塞的趋势。有些病人的冠状动脉呈弥散性扩张,但不规则,此过程现在一般认为是冠状动脉扩张,这是明确的病理变化。
Atherosclerotic vessels are usually narrow, and at necropsy, coronary arteries of patients with myocardial infarction are narrower than controls. This narrow formation is primarily a result of deposition and fibrosis of the lining of the intima, but often shows focal scarring in the middle of the vessel, with even concentric atrophy of elastic or muscular tissue. Like the aorta, coronary arteries often progressively expand throughout their life, but whether this is a natural aging process or a cardiac hypertrophy response remains controversial. In theory, expanding the coronary arteries to the appropriate level should help reverse the tendency for atherosclerotic occlusions. In some patients, the coronary arteries diffusely disseminate but irregularly and this process is now generally considered to be coronary artery dilatation, which is a definite pathological change.