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Introduction to Cardiovascular Pathology - Fred Clayton. Systemic Pathology of Congestive Heart Failure Pathology of Myocarditis Pathology of Cardiomyopathy Dilated Cardiomyopathy Hypertrophic Cardiomyopathy Restrictive Cardiomyopathy. Congestive Heart Failure.
macrophages “heart failure cells”, with
iron stain to right
Liver – chronic passive congestion – red cell pooling near central veins
and pericentral necrosis of the hepatocytes
Myocarditis – meets Dallas criteria of a T lymphocyte infiltrate and myocyte
necrosis or dropout. This is usually either viral or of unknown cause.
Diphtheria myocarditis – due to a toxin rather than bacterial invasion. There is
some inflammation, myocyte changes (see the big nucleolus). Myocyte necrosis
(not shown) also happens.
Cardiomyopathy – trichrome stain showing extensive fibrosis (blue) between
the myocytes. The myocytes also vary in size, and some have partial loss of
Loss of fibrils in cardiomyopathy. The myocyte at lower left is about normal; the
others have an extensive loss of myofibrils.
Cardiomyopathy – loss of fibrils and a small contraction band in the top center.
Hypertrophic cardiomyopathy – myofiber dysarray – not all fibers are pulling
the same direction. Thus the contraction is ineffective. However, the cardiac
conduction system can have these same problems, which might cause the
arrhythmias and sudden death these patients tend to die of.
Amyloidosis – this heart is thickened, pale, and has a rubbery consistency that
interferes with cardiac expansion during diastole.
Endomyocardial fibrosis – fibrosis under the endocardium and in the the inner
third of the myocardium.
Endomyocardial fibrosis of a ventricular wall. When extensive, this would cause
restrictive heart failure too.
Heart - Becker’s muscular dystrophy – looks like idiopathic dilated cardiomyopathy.
By electron microscopy, this was Adriamycin toxicity. See the clear vacuoles (they
are dilated sarcoplastic reticulum) and severe loss of myofibrils.
Cocaine heart – necrosis with contraction bands. This could happen with any
severe chronic stimulation such as too much pressors in a failing heart or a
Cardiac Sarcoidosis – well defined granuloma with giant cells. Dosen’t infiltrate &
destroy myocardium like giant cell myocarditis. Eosinophils are less common in sarcoidosis than in giant cell myocarditis.
Hemochromatosis - note the brown perinuclear deposits of hemosiderin. It is,
however, the soluble iron, not the hemosiderin, that is considered toxic.
Rheumatic fever – Aschoff body – A collection of cells, often near a vessel, with a
few multinucleate cells and some vesicular nuclei with big nucleoli (Aschoff cells). Anichkov myocytes (not shown) are myocytes with very elongated big nucleoli. This is a marker for rheumatic fever, but the serious damage is to the valves.