By E. G. J. Olsen MD, FRC Path., FACC, R. A. Florio FILMS (auth.)
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Histochemistry Patchy or uniform depletion of the enzyme systems, already mentioned above, and of glycogen occurs. Ultrastructural Changes Experimental Studies These have permitted insight into the process of hypertrophy. Sequential changes following induction of isometric hyperfunction have been described. Three stages are recognized. (1) First stage or stage of damage. Cloudy swelling and a fatty change together with faintly eosinophilic staining of myocardial fibres can be observed. Trauma and rupture of the papillary muscle or chordae tendineae are encountered clinically in this stage of hypertrophy.
On transverse sections the material is located in the outer rim of the fibres and in partly affected fibres nuclei and cytoplasm are normal. Basophilic change can readily be observed in the ventricular myocardium, particularly the posterior aspect of the left ventricle. It has also been identified in the left atrial appendage. 7). Microscopically, amyloid consists of laminated deposits which are occasionally related to blood vessels. Alternatively amyloid may be diffusely distributed between myocardial fibres.
The lesions may also be encountered on the left side of the heart. Histological appearances consist of superimposition of the abnormal material on the original endocardium, which is usually intact. 16). Some lymphocytes, plasma cells and mast cells can also often be identified. Diagnosis, therefore, is easily achieved by the presence of metachromasia and the absence of elastic tissue. The latter is found in all other types of endocardial thickening. Pathogenesis of the endocardial lesion Three factors in the production of the heart lesions have been proposed although their pathogenesis is still debated: (1) dilatation of the right side of the heart during an attack of flushing; (2) local serotonin action resulting in deposition of fibrin and platelets; (3) altered tryptophan metabolism, together with hypoproteinaemia and hypovitaminosis, which leads to lowering of tissue resistance to trauma 6 .