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Case Reports
. 2018 Apr;110(4):388-392.
doi: 10.5935/abc.20180065.

Case 2/2018 - 73-Year-Old Male with Ischemic Cardiomyopathy, Cachexia and Shock

[Article in Portuguese, English]
Rafael Amorim Belo Nunes  1 , Jussara de Almeida Bruno  1 , Hilda Sara Monteiro Ramirez  1 , Léa Maria Macruz Ferreira Demarchi  1
Affiliations
Case Reports

Case 2/2018 - 73-Year-Old Male with Ischemic Cardiomyopathy, Cachexia and Shock

[Article in Portuguese, English]
Rafael Amorim Belo Nunes et al. Arq Bras Cardiol. 2018 Apr.
No abstract available

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Figures

Figure 1
Figure 1
ECG: left atrial overload and indirect signs of right atrial overload (Peñaloza-Tranchesi), in addition to left bundle-branch block and left anterior hemiblock.
Figure 2
Figure 2
A and B: Cross sections of the ventricles in the middle-basal and apical regions, respectively. Healed transmural infarction in the left ventricular anterior and lateral walls and in the anterior two-thirds of the ventricular septum, with aneurysmal formation. Myocardial hypertrophy of the left ventricular walls not affected by the infarction is evident. Organizing thrombus in the endocardium of the left ventricular anterior and septal walls (arrow) in the middle-basal region, extending to the apical region (tr). Organizing thrombus in the right ventricular endocardium of the apex (arrow). C and D: Histological sections of the left ventricular aneurysm showing an isolated group of cardiomyocytes (m) and focal calcification (ca) amid mural fibrosis (f). Hematoxylin-eosin, 25x.
Figure 3
Figure 3
Histological sections of epicardial coronary arteries. Calcified atherosclerosis with luminal obstruction greater than 50% in the major branches. In the first centimeter of the right coronary artery (RC1), there is diffuse intimal fibrosis, with no lipid. In the first centimeter of the posterior interventricular branch of the right coronary artery (PD1) and of the circumflex branch (CX1), there are atherosclerotic plaques with fatty center and cholesterol crystals (arrows), surrounded by fibrosis (F). In the fourth centimeter of the anterior interventricular branch (AD4), there is luminal occlusion by an old recanalized thrombus, with multiple lumina and small vessels formed in the repairing process (*). Hematoxylin-eosin, 25x (RC1, CX1 and AD4) and 50x (PD1).
Figure 4
Figure 4
Chronic passive congestion. Lungs: thickening and tortuosity of the veins (A) and muscularization and hypertrophy of the media layer of an intra-acinar arteriole (B). Liver: sinusoidal dilatation in centrilobular areas (C). Spleen: intense congestion and widening of the red pulp; small, non-reactive lymphoid follicles (*). Hematoxylin‑eosin, 100x (A and D) and 400x (B). Masson trichrome, 50x (C).
Figure 5
Figure 5
Lungs (A and B). Aspiration pneumonia: alveolar spaces filled with dense suppurative neutrophilic inflammatory infiltrate (*), amid which, particulate food material and filamentous bacterial aggregates, morphologically compatible with Actinomyces (arrows), can be seen. Hematoxylin-eosin, 100x (A).
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References

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