Journal of the Practice of Cardiovascular Sciences

: 2016  |  Volume : 2  |  Issue : 3  |  Page : 190--191

Cardiovascular pathology quiz

Sudheer Arava, Pradeep Immanuel, Ruma Ray 
 Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

Correspondence Address:
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029

How to cite this article:
Arava S, Immanuel P, Ray R. Cardiovascular pathology quiz.J Pract Cardiovasc Sci 2016;2:190-191

How to cite this URL:
Arava S, Immanuel P, Ray R. Cardiovascular pathology quiz. J Pract Cardiovasc Sci [serial online] 2016 [cited 2023 Feb 7 ];2:190-191
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Following are the endomyocardial biopsies (EMCBs) of two patients for comparison and interpretation.

Case 1

A 34-year-old male presented with the clinical diagnosis of restrictive cardiomyopathy. EMCB for interpretation [Figure 1].{Figure 1}

Case 2

A 45-year-old female presented with dilated cardiomyopathy. EMCB for interpretation [Figure 2].{Figure 2}

 View Answer

 Answer 1


Hematoxylin and eosin stained slides [Figure 3]a and [Figure 3]b, arrow] show a sparsely cellular fibrous tissue fragments (blue-colored spindle-shaped cells are fibroblasts) with absence of endocardial and myocardial tissue. Immunostain for smooth muscle actin (SMA) [Figure 3]c highlights the vascular channels (brown color, arrow) in the fibrous tissue. It represents a thickened and vascularized endocardium. In the clinical context of restrictive heart disease, these features are suggestive of endomyocardial fibrosis.[1],[2]{Figure 3}

 Answer 2


Hematoxylin and eosin stained slides [Figure 4]a and [Figure 4]b, arrow] show a cellular fibrous tissue fragment (indicates lamina fibrosa layer of the heart valve) with lack of myocardial tissue (compare the amount of blue-colored spindle-shaped cells with pictures of case 1).

Immunostain for SMA [Figure 4]c reveals absence of permeating vascular channels indicating the avascular valve tissue (compare the amount of brown-colored vessels with the case 1). The tricuspid valvular tissue was inadvertently biopsied while performing an EMCB.[3],[4]{Figure 4}

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Conflicts of interest

There are no conflicts of interest.


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2Chopra P, Narula J, Talwar KK, Kumar V, Bhatia ML. Histomorphologic characteristics of endomyocardial fibrosis: An endomyocardial biopsy study. Hum Pathol 1990;21:613-6.
3Hinton RB, Yutzey KE. Heart valve structure and function in development and disease. Annu Rev Physiol 2011;73:29-46.
4Misfeld M, Sievers HH. Heart valve macro- and microstructure. Philos Trans R Soc Lond B Biol Sci 2007;362:1421-36.