This 68-year-old man initially sought medical advice five years prior came to his death. His symptoms at that time were the hospital with complaints of exercise intolerance and occasional peripheral edema. He gave a history of a "heart murmur" that was diagnosed 25 20 years ago during an employment physical. No but no follow up care had been given for this murmur. On examination the patient had peripheral edema and shortness of breath and a chest x-ray revealed significant cardiac enlargement and pulmonary edema with bilateral pleural effusions. He sustained a cardiac arrest shortly after admission and could not be resuscitated. Autopsy disclosed a markedly enlarged heart weighing 650 grams. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found.

== Images ==<gallery heights="250px" widths="250px">File:IPLab2Hypertrophy1.jpg|This is a gross photograph of a cross section of a normal human heart taken at autopsy (right) and the heart from this case, which demonstrates concentric hypertrophy of the left ventricular wall. Note the marked thickening of the left ventricular wall. There is also moderate thickening of the right ventricular wall.File:IPLab2Hypertrophy2.jpg|This low-power photomicrograph shows normal myocardium (left) compared to hypertrophied myocardium (right).File:IPLab2Hypertrophy3.jpg|Normal myocardium (left) is compared here to hypertrophied myocardium (right). The muscle fibers are thicker and the nuclei are larger and darker in the hypertrophied myocardium.The clear spaces between the muscle fibers are due to processing artifacts and are not present during life.File:IPLab2Hypertrophy4.jpg|Normal myocardium (left) is compared to hypertrophied myocardium (right). This high power view demonstrates the large dark nuclei (arrow) found in hypertrophied cardiac muscle cells. Polyploidy is a common feature in cardiac hypertrophy. Also note the increased size (thickness) of the individual cardiac muscle cell on the right compared to normal cardiac myocytes (left).File:IPLab2Hypertrophy5.jpg|This autopsy specimen was taken from another patient's terminal admission was for signs who had cardiac hypertrophy and congestive heart failure that resulted in dilation of severe the cardiac chambers. This heart was markedly enlarged (700 grams) but the congestive failure--leads to dilation of the chambers and thinning of the wall. Note the patient had marked peripheral edema dilation of both the left (1) and shortness right (2) ventricular chambers.File:IPLab2Hypertrophy6.jpg|This gross photograph shows an example of breath normal physiologic hypertrophy. The organs shown are an open uterus (1), cervix (2) and chest x-ray revealed significant cardiac enlargement vagina (3), both ovaries (4) and pulmonary edema with bilateral pleural effusions. He sustained both kidneys (5) from a cardiac arrest woman who died shortly after admission and could not be resuscitatednormal delivery from causes unrelated to childbirth. Note the marked thickening of the uterine wall due to smooth muscle cell hypertrophy. </gallery> == Virtual Microscopy ===== Myocardial Hypertrophy ===<peir-vm>IPLab2Hypertrophy</peir-vm>

== Autopsy Findings = Normal Heart ===Autopsy disclosed a markedly enlarged heart weighing 650 grams and having dilated chambers. The aortic valve was calcified and showed evidence of stenosis and insufficiency. The coronary arteries were narrowed 60 to 70% by atherosclerosis. No acute coronary occlusions were found and there was no evidence of myocardial infarction.<peir-vm>IPLab2Hypertrophy_normal_Heart</peir-vm>

== Images Study Questions ==* <galleryspoiler text="Is this case of myocardial hypertrophy an example of physiologic or pathologic hypertrophy?">Pathologic.</spoiler>File:IPLab2MyocardialHypertophy1.jpg|This is a gross photograph * <spoiler text="What are some factors that lead to the decompensation of a cross section of a normal human this heart taken at autopsy (right) and the ?">The exact mechanism for why hypertrophied hearts go on to develop congestive heart from this casefailure is not known. However, which demonstrates concentric hypertrophy some contributing factors may include:# limitation of the left ventricular wall. Note vascular supply to the marked thickening enlarged myocardial fibers,# diminished oxidative capabilities of the left ventricular wall. There is also moderate thickening of mitochondria,# alterations in protein synthesis & degradation, or# alterations in the right ventricular wallcytoskeleton.</spoiler> == Additional Resources == === Reference ===File* [http:IPLab2MyocardialHypertophy2//emedicine.jpg|This lowmedscape.com/article/890068-power photomicrograph shows normal myocardium (left) compared to hypertrophied myocardium (right)overview eMedicine Medical Library: Pediatric Hypertrophic Cardiomyopathy]* [http://emedicine.medscape.com/article/163062-overview eMedicine Medical Library: Heart Failure]File* [http:IPLab2MyocardialHypertophy3//www.merckmanuals.com/professional/cardiovascular_disorders/cardiomyopathies/hypertrophic_cardiomyopathy.jpg|Normal myocardium (left) is compared here to hypertrophied myocardium (right)html Merck Manual: Hypertrophic Cardiomyopathy]* [http://www. The muscle fibers are thicker and the nuclei are larger and darker in the hypertrophied myocardiummerckmanuals.The clear spaces between the muscle fibers are due to processing artifacts and are not present during lifecom/professional/cardiovascular_disorders/heart_failure/heart_failure_hf.html Merck Manual: Heart Failure] === Journal Articles ===File* Amann K, Rychlík I, Miltenberger-Milteny G, Ritz E. [http:IPLab2MyocardialHypertophy4//www.jpg|Normal myocardium (left) is compared to hypertrophied myocardium (right)ncbi.nlm. This high power view demonstrates the large dark nuclei (arrow) found in hypertrophied cardiac muscle cellsnih. Polyploidy is a common feature gov/pubmed/9839289 Left ventricular hypertrophy in cardiac hypertrophyrenal failure]. Also note the increased size (thickness) of the individual cardiac muscle cell on the right compared to normal cardiac myocytes (left) ''Kidney Int Suppl'' 1998 Dec;68:S78-85.File* Khan IA, Ajatta FO, Ansari AW. [http:IPLab2MyocardialHypertophy5//www.jpg|This autopsy specimen was taken from another patient who had cardiac hypertrophy and congestive heart failure that resulted ncbi.nlm.nih.gov/pubmed/10337893 Persistent ST segment elevation: a new ECG finding in dilation of the cardiac chambershypertrophic cardiomyopathy]. This heart was markedly enlarged ''Am J Emerg Med'' 1999 May;17(700 grams3) but the congestive failure leads to dilation of the chambers and thinning of the wall:296-9. === Images ===* [{{SERVER}}/library/index. Note the marked dilation of both the left (1) and right (2) ventricular chambersphp?/tags/76-cardiomyopathy PEIR Digital Library: Cardiomyopathy Images]* [{{SERVER}}/library/index.php?/tags/1202-hypertrophy_biventricular PEIR Digital Library: Cardiac Hypertrophy Images]File* [http:IPLab2MyocardialHypertophy6//library.jpg|This gross photograph shows an example of normal physiologic hypertrophymed. The organs shown are an open uterus (1), cervix (2) and vagina (3), both ovaries (4) and both kidneys (5) from a woman who died shortly after normal delivery from causes unrelated to childbirthutah. Note the marked thickening of the uterine wall due to smooth muscle cell hypertrophyedu/WebPath/CVHTML/CVIDX.html#11 WebPath: Cardiomyopathies] == Related IPLab Cases == * [[IPLab:Lab 6:Scleroderma|Lab 6: Lung: Scleroderma]]  </gallery>{{Template:IPLab 2}} [[Category:IPLab:Lab 2]]