Case 1/2017 - 26-Year-old Male with Rapidly Progressive Heart Failure

Figures

• 

  Figure 1. Electrocardiogram: atrial flutter with high-degree atrioventricular block, antero-superior divisional block, and right bundle-branch conduction disorder.

• 

  Figure 2. Transthoracic echocardiogram, longitudinal parasternal view (a, b, c) and four-chamber view (d) of the left ventricle. Note the enlarged atria and right ventricle.

• 

  Figure 3. Chest X-ray (posteroanterior). Marked cardiomegaly, rectified middle arch and free pulmonary fields.

• 

  Figure 4. Transthoracic echocardiogram (April 2013): biventricular and biatrial enlargement.

• 

  Figure 5. Chest X-ray (anteroposterior - bed). Marked cardiomegaly and free pulmonary fields.

• 

  Figure 6. Gross aspect of the heart (four-chamber section). Significant fatty infiltration of the myocardium at the right ventricular base and apex, better evidenced in the magnifications (left panels). In addition, note global cardiomegaly with thinning of cardiac walls and biventricular dilatation.

• 

  Figure 7. Gross aspect of the heart, longitudinal section of the right ventricular inlet and outflow tract. Both show focal fibrofatty replacement in the myocardial. Pulm T. - pulmonary trunk.

• 

  Figure 8. Microscopic sections of the right ventricular wall. Left panel: replacement of the muscle tissue with fibrofatty tissue. Right panel: the fibrotic component is better evidenced. Hematoxylin-Eosin objective magnifications, X 2.5 left and X 10 right, respectively.

• 

  Figure 9. Microscopic sections of the right ventricular wall left panel and of the ventricular septum right panel. Left panel focal lympho-histiocytic inflammatory infiltrate and fibrosis between the cardiomyocytes. In addition to the fibrotic component, fatty tissue can be seen in the left upper corner of the image. Right panel arterial thickening in the septal myocardium due to hypertrophy of the tunica media. Hematoxylin-Eosin objective magnifications, X 20 left and X 5 right, respectively.