Severe Cardiomegaly in Congestive Heart Failure: Postmortem Evidence of Cardiac Remodeling.

BACKGROUND

Cardiomegaly is the gross manifestation of advanced cardiac remodeling, a compensatory response to prolonged hemodynamic stress. Direct postmortem examination of cardiac remodeling is rare, because cardiomegaly is clinically identified through radiologic imaging.

CASE SUMMARY: An 81-year-old male cadaveric donor with congestive heart failure as the known cause of death was dissected under standard procedure. Gross examination revealed severe enlargement of the heart and marked dilation of the aorta. Microscopic examination demonstrated significant left ventricular myocyte hypertrophy. Comparative analysis with 5 additional male donors confirmed that the structural findings were statistically significant across all measurements.

DISCUSSION: The known history, gross structural findings, and microscopic features favor a hypertensive etiology and reinforce the structural basis of heart failure usually inferred from clinical imaging.

TAKE-HOME MESSAGE: Postmortem visualization of cardiac structural morphology provides a unique educational opportunity to correlate gross pathology with common etiologies and appreciate how cardiovascular remodeling contributes to the clinical progression of congestive heart failure.