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This 68-year-old man initially sought medical advice five years prior to his death. His symptoms at that time were exercise intolerance and occasional peripheral edema. He gave a history of a "heart murmur" that was diagnosed 25 years ago during an employment physical. No follow up care had been given for this murmur.
The patient's terminal admission was for signs of severe heart failure--the patient had marked peripheral edema and shortness of breath and chest x-ray revealed significant cardiac enlargement and pulmonary edema with bilateral pleural effusions. He sustained a cardiac arrest shortly after admission and could not be resuscitated.
== Autopsy Findings ==
File:IPLab2Hypertrophy6.jpg|This gross photograph shows an example of normal physiologic hypertrophy. The organs shown are an open uterus (1), cervix (2) and vagina (3), both ovaries (4) and both kidneys (5) from a woman who died shortly after normal delivery from causes unrelated to childbirth. Note the marked thickening of the uterine wall due to smooth muscle cell hypertrophy.
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== Virtual Microscopy ==
=== Myocardial Hypertrophy ===
<peir-vm>IPLab2Hypertrophy</peir-vm>
=== Normal Heart ===
<peir-vm>IPLab2Hypertrophy_normal_Heart</peir-vm>
== Study Questions ==
* <spoiler text="Is this case of myocardial hypertrophy an example of physiologic or pathologic hypertrophy?">Pathologic.</spoiler>
* <spoiler text="What are some factors that lead to the decompensation of this heart?">The exact mechanism for why hypertrophied hearts go on to develop congestive heart failure is not known. However, some contributing factors may include:
# limitation of the vascular supply to the enlarged myocardial fibers,
# diminished oxidative capabilities of the mitochondria,
# alterations in protein synthesis & degradation, or
# alterations in the cytoskeleton.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/890068-overview eMedicine Medical Library: Pediatric Hypertrophic Cardiomyopathy]
* [http://emedicine.medscape.com/article/163062-overview eMedicine Medical Library: Heart Failure]
* [http://www.merckmanuals.com/professional/cardiovascular_disorders/cardiomyopathies/hypertrophic_cardiomyopathy.html Merck Manual: Hypertrophic Cardiomyopathy]
* [http://www.merckmanuals.com/professional/cardiovascular_disorders/heart_failure/heart_failure_hf.html Merck Manual: Heart Failure]
=== Journal Articles ===
* Amann K, Rychlík I, Miltenberger-Milteny G, Ritz E. [http://www.ncbi.nlm.nih.gov/pubmed/9839289 Left ventricular hypertrophy in renal failure]. ''Kidney Int Suppl'' 1998 Dec;68:S78-85.
* Khan IA, Ajatta FO, Ansari AW. [http://www.ncbi.nlm.nih.gov/pubmed/10337893 Persistent ST segment elevation: a new ECG finding in hypertrophic cardiomyopathy]. ''Am J Emerg Med'' 1999 May;17(3):296-9.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/76-cardiomyopathy PEIR Digital Library: Cardiomyopathy Images]
* [{{SERVER}}/library/index.php?/tags/1202-hypertrophy_biventricular PEIR Digital Library: Cardiac Hypertrophy Images]
* [http://library.med.utah.edu/WebPath/CVHTML/CVIDX.html#11 WebPath: Cardiomyopathies]
== Related IPLab Cases ==
* [[IPLab:Lab 6:Scleroderma|Lab 6: Lung: Scleroderma]]
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[[Category:IPLab:Lab 2]]