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| Fibrosis |
| Etiology •Most common cause is coronary arteriosclerosis. •Other causes: 1. Relative coronary insufficiency due to cardiac hypertrophy due to hypertension, valvular disease, or unknown causes. 2. Healed rheumatic myocarditis. 3. Healed multiple micro-infarcts due to emboli from vegetations of an infectious endocarditis. 4. Healed infectious, immune, toxic, or idiopathic myocarditis. 5. Scleroderma. |
| Pathogenesis •Coronary occlusive disease and/or cardiac hypertrophy result in chronic ischemia with necrosis and fibrosis. •Repeated attacks of angina pectoris each represent a micro-infarct, with the evolution of confluent subendocardial scars. •Other causes cause myocardial necrosis directly and heal as scars., |
| Epidemiology •Varies with different underlying causes. |
| General Gross Description •Scars due to occlusive or relative coronary insuffuciency are typically subendocardial. •Scars due to myocarditis of diverse etiologies are more random. •Focal Scarring due to scleroderma is uniformly widespread. |
| General Microscopic Description •The histology of scarring is non-specific, and of no value to the determination of etiology. •Scar consists of fibroblasts and collagen |
| Clinical Correlation •Coronary insufficiency is characterized by chest pain and angina pectoris, and, eventually, by heart failure. •Myocardial scarring of other causes correlates with the evolution of congestive heart failure. •Scarring of any etiology may cause arrhythmias |
| References • Cotran RS, Kumar V, Robbins SL: Robbins Pathologic Basis of Disease. 5th ed. Philadelphia, W.B. Saunders, 1994, pp. 523-566. |
| Fibrosis |
| Synopsis by: J. Hasson, MD (T33010M49000)[339] |
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