Chronic Heart Failure of Ischemic Origin in Pathologists’ Practice

To characterize the patients with ischemic heart disease and severe cardiac dysfunction we use the term "chronic heart failure of ischemic origin" (CHFIO) with the proviso that we meen the patients with impaired left ventricular systolic function. CHFIO – a pathological condition of the myocardium, accompanied by increase in all chambers of the heart to the degree of cardiomegaly, often with irregular thickening of its walls and the phenomena of diffuse and focal substitute fibrosis that develops against atherosclerotic coronary artery disease, but not because of the formation of ventricular aneurysm, organic pathology valvular heart or presence of pathological communications. The aim was to analyze autopsies for 10-year period (2005-2014) in postmortem department of Military Medical Center of the Western Region (MMCWR), Lviv regional postmortem bureau and centralized postmortem department of the Ivano-Frankivsk regional hospital with a view of pathoanatomical pattern evaluation and formulation characteristics at diagnosis CHFIO; conduct a clinical and morphological analysis fatal case of CHFIO in MMCWR. The object of the research was the postmortem reports and research on the death of a man of CHFIO 60 years old. Results and discussion. The analysis of autopsies for 10-year period (2005-2014) showed that none of the protocols of postmortem studies display “CHFIO” in the section "pathoanatomical diagnosis". This indicates about insignificant knowledge of pathologists in CHFIO, despite the presence of autopsies with signs of chronic venous hyperemia of cardiac origin, cardiomegaly on a background of chronic ischemic heart disease, mostly large focal cardiosclerosis, with advanced atherosclerotic lesions of the coronary arteries. These cases mainly regarded as a manifestation of dilated cardiomyopathy or hypertension, rarely a heart disease, a diabetic cardiomyopathy, which combined with chronic ischemic heart disease on the background of coronary atherosclerosis. We also describe a lethal case of CHFIO that developed in patient with existing chronic ischemic heart disease and hypertension and without of primary heart defect and diabetes. According to history, he suffers from coronary heart disease since 2000, in 2003 suffered a myocardial infarction on the back wall of the left ventricle. Since 2011, the health gradually deteriorated, decreased exercise tolerance, increased the number of attacks. According to the postmortem study the heart almost globular shape, size 12,5x14,0x8,5 cm, weight 695 gr., tip is smoothed. Contour of enlarged heart due of the left. The cavities of the heart, especially the left-wing sections both atria and ventricles are much extended. Left ventricular wall thickness is uneven – 1.4-1.8 cm, interventricular septum – 1.3 cm, the right ventricle – 0.5-0.7 cm. Papillary muscles of the mitral and tricuspid valves thickened and shortened, thick chordal thread and elongated. Mitral valve flexible, thin, whitish-gray, not completely cover for closing the hole. All other valves wings translucent, flexible, thin, visually perimeters are not changed. Myocardium throughout condensed, reddish-brown, fibrous, with diffuse gray layers and excrescence of large gray area in the projection of the posterior wall of the left ventricle of the transition to the posterior interventricular septum and spread on top of the heart. Lumen right, trunk and left circumflex coronary artery is straitened about 90% by circular whitish-gray masses with calcification. The orifices of the left and right coronary arteries are instrumental impassable. Thus, in pathological practice, we meet manifestations of chronic heart failure of ischemic origin, which must be displayed pathoanatomical diagnosis as "cardiomegaly of ischemic origin".