Volume 04 Issue 06-2024
79
American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
–
2771-2753)
VOLUME
04
ISSUE
06
P
AGES
:
79-86
OCLC
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1121105677
Publisher:
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Servi
ABSTRACT
Effects of alcohol metabolites, mainly acetaldehyde, on the heart. Disturbances in metabolism and electrolyte
imbalance lead to arrhythmias and disturbances in the functional activity of the heart. Acetaldehyde disrupts the
synthesis of several compounds and increases the synthesis of inflammatory cytokines and leads to the development
of an autoimmune process. The weight of the heart is 500-550 gr. and it is observed that it is filled with fat. When the
heart is placed on the operating table, it is diffuse, similar to infectious myocarditis, and the heart is red or purple in
color.
KEYWORDS
Alcohol, cardiomyocyte, heart, ventricle, compartment, dystrophy.
INTRODUCTION
In recent years, according to WHO data and
epidemiological studies, diseases of the cardiovascular
system remain dominant in economically developed
countries. Cardiomyopathies are an important part of
cardiovascular diseases with their severe course and
numerous life-threatening complications [3,5]. There
are several types of cardiomyopathies, one of which is
alcoholic cardiomyopathy. The relevance of alcoholic
CMP is determined by its relatively frequent
occurrence, development along with other heart
diseases, and in most cases it leads to sudden death. It
has been confirmed that 15% of patients with chronic
alcoholism suffer from alcoholic CMP and 18% of them
die accidentally [1,4].
Research Article
CHARACTERISTICS OF PATHOMORPHOLOGICAL CHANGES OF
ALCOHOLIC CARDIOMYOPATHY
Submission Date:
June 20, 2024,
Accepted Date:
June 25, 2024,
Published Date:
June 30, 2024
Crossref doi:
https://doi.org/10.37547/ajbspi/Volume04Issue06-11
Oripova Ozoda Olimovna
Samarkand State Medical University, Samarkand, Uzbekistan
Journal
Website:
https://theusajournals.
com/index.php/ajbspi
Copyright:
Original
content from this work
may be used under the
terms of the creative
commons
attributes
4.0 licence.
Volume 04 Issue 06-2024
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American Journal Of Biomedical Science & Pharmaceutical Innovation
(ISSN
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2771-2753)
VOLUME
04
ISSUE
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79-86
OCLC
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1121105677
Publisher:
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Servi
This type of CMP develops from the specific effects of
alcohol on the heart. The main reason is chronic alcohol
consumption, drinking 100 ml every day for 10-20 years.
Histological examination reveals that the muscle fibers
are thickened and there are many connective tissue
fibers between the muscles, the typical characteristic
of this KMP is that the interstitial tissue is wide, the
muscle fibers are stiffened, and there are large thrombi
attached to the inner wall of the left ventricle [2,6].
The purpose of the research
: to clarify the specific
macro- and microscopic changes of the heart in
alcoholic cardiomyopathy;
METHODS
We reviewed 5,642 reports from the RPAM autopsy
department during 2011-2020, and a total of 64 CMPs
were identified during this period, accounting for 1.13%
of all autopsies and 4.7% of cardiovascular diseases. 11
of the 64
identified cases were alcoholic
cardiomyopathy. After macroscopic examination of
the heart, 1.5x1.5x0.5 cm pieces taken from the walls of
both ventricles and both compartments were frozen in
a 10% solution of formalin in phosphate buffer for 48
hours, then washed in running water for 3-4 hours and
placed in a series of alcohol batteries of increasing
concentration (80˚ , 90˚, 96˚, 96˚, 100˚) and dehydrated
in chloroform, paraffin with added wax was poured,
and bricks were prepared. Histological sections 5-
6 μm
thick were taken from paraffin blocks and stained with
hematoxylin-eosin and van Gieson stain to identify
connective tissue fibers. Histological preparations
were studied in 10, 20, 40 lenses of a light microscope,
and pictures were taken from the necessary areas.
RESULTS
Due to the chronic intoxication of the div under the
influence of alcoholic KMP ethanol, in most cases, due
to the lack of proteins and thiamine in the heart tissue,
all parts of the organ become enlarged almost to the
same extent, their cavities expand, often the right
ventricle becomes enlarged and dilated. In our
material, 14 cases of alcoholic KMP were detected, all
of which had a dramatically enlarged heart, with an
average weight of 582.7 g. it was observed that the
heart was filled with fat in some of them. It was
observed that the heart was macroscopically enlarged,
reddish in color, softened in consistency, and spread
out like dough when placed on the table. From the
cavities of the heart, it was often found that the right
ventricle was suddenly enlarged, and its wall was
dilated.
Microscopic examination of this condition revealed
that this type of KMP is a characteristic change, that is,
the myocardial interstitial tissue is strongly swollen, as
a result of which each of the muscle fibers is shriveled
and located separately (Fig. 1). Separated muscle fibers
are crooked, some of them are cracked, the transverse
extension lines are not well visible, they are sparse.
Cardiomyocyte nuclei are few and those that are
present are hypertrophied and enlarged. It is
determined that the connective fibers in the interstitial
tissue are shortened and turned into a sparse network,
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and the cells are suspended. It is observed that the
swelling of the interstitium is even stronger in the areas
where the blood vessels are located, as a result of
which the structural units of the connective tissue are
disintegrated, blood is poured around the vessels in a
diapedesis manner. It is determined that the wall of the
arterial blood vessels is narrowed due to sclerosis, the
tissue structures in the wall are dense with each other
and form a whole layer. It is observed that the blood
vessels of the vein are sharply expanded, the wall is
thinned, the cavity is filled with blood, blood is poured
around it in a diapedesis method (Fig. 2). It is
determined that the murash fibers located in this area
are shriveled and fragmented, some of them undergo
myolysis, and others undergo vacuolization.
In most cases of alcoholic KMP, it is determined that
the interstitial swelling spread in the myocardial tissue
simultaneously spreads to the interstitial tissue and the
cytoplasm of parenchymatous cells, that is,
cardiomyocytes. This condition is called myocardosis,
the reason for which is a metabolic disorder in
alcoholism, that is, due to a violation of the protein
synthesizing function of the liver, there is less protein
in the myocardium, instead of it, thiamine substance
increases, and the swelling process develops in both
interstitial tissue and cardiomyocytes. Microscopically,
small vacuoles appeared in the sarcoplasm of some
cardiomyocytes, while in others, a tumor center
appeared under the outer cytolemma (Fig. 3), around
myofibrils. In this case, it is determined that the nucleus
and myofibrils of cardiomyocytes are pushed to the
edge of the cell.
Figure 1. Alcoholic KMP. Myocardial interstitial tissue is severely swollen and muscle fibers are separated from
each other. Paint: G-E. Floor: 10x40.
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Figure 2. Alcoholic KMP. Myocardial artery wall is narrowed due to thickening, veins are widened and full. Paint: G-
E. Floor: 10x40.
Figure 3. Alcoholic KMP. Intracellular and extracellular edema in the myocardium. Paint: G-E. Floor: 10x40.
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Figure 4. Alcoholic KMP. Interstitial tissue tumor, sclerosis in and around the artery wall, development of
destruction in the wall. Paint: G-E. Floor: 10x10.
As characteristic changes of alcoholic KMP, a strong
swelling of the interstitial tissue and the wall of blood
vessels and around it, as well as the growth of
connective
tissue,
were
noted.
In
this
photomicrograph, it is clearly seen that due to the
development of a very strong swelling in the interstitial
tissue of the myocardium, muscle fibers are separated
and torn. If we pay attention to the wall of the artery,
it is determined that the connective tissue has a
different thickness due to growth and destruction. In
one part of the arterial wall, it is determined that the
tissue structures have hardened, fatty substances have
accumulated between them, and even spread to the
endothelium layer, bulging it (Fig. 4).
Another reason for myocardium swelling and dilatation
in alcoholic KMP is that the process of extracellular and
intracellular swelling in some areas of the myocardium
eventually destroys the sarcoplasm and myofibrils of
cardiomyocytes and leads to myolysis (Fig. 5). In this
area, accumulation of lymphohistiocytic cells in the
interstitial tissue and around blood vessels, their
activation and hypertrophy and hyperchromasia are
determined. As another pathological change in the
composition of cardiomyocyte cells, foci of
lipofuscinosis and calcinosis are observed.
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Figure 5. Alcoholic KMP. Due to extracellular and intracellular swelling, sarcoplasm and myofibrils of
cardiomyocytes were shriveled and subjected to myolysis. Paint: G-E. Floor: 10x40.
Figure 6. Alcoholic KMP. The appearance and proliferation of fat cells and histiocytic cells in the interstitial tissue
of the myocardium. Paint: G-E. Floor: 10x40.
Microscopic examination of myocardial tissue in
alcoholic
KMP
revealed
another
specific
pathomorphological change. Since these data are not
found in the scientific literature, we will describe the
comprehensive histological picture. In some areas of
the interstitial tissue of the myocardium, the
proliferation of connective tissue cells, i.e. histiocytic
cells, among them, metaplasia of histiocytic cells into
fat cells was found (Fig. 6). It can be distinguished that
in fact it has been confirmed that fat cells grow into the
interstitium of the myocardium from the adipose tissue
under the epicardium. In our material, it was found that
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fat cells, i.e., lipocytes, arise by metaplasia from
interstitial tissue histiocytes. Proliferation and increase
of histiocytic cells is observed in the composition and
space of muscle fibers around this area. In cases of
alcoholic KMP, foci of histiocytic proliferation and
lipomatous metaplasia in the interstitial tissue of the
myocardium are enlarged due to the increase of
adipocytes, fat cells are scattered around. Around such
foci, it is determined that there is an increase in fat
cells, different morphofunctional conditions, that is,
there are cells rich in granules and cells with reduced
granules (Fig. 7). In the places where fat cells are
located, it is determined that both interstitial tissue
and muscle tissues are dystrophied and destroyed.
Figure 7. Alcoholic KMP. The appearance of fat cells in the lipomatous area of the intermediate tissue. Paint: G-E.
Floor: 10x40.
Figure 8. Alcoholic KMP. Metaplasia of histiocytic cells to lipocytes in the interstitial tissue of the myocardium.
Paint: G-E. Floor: 10x40.
Pathomorphological changes that develop in the
myocardium in alcoholic CMP have been confirmed to
have a specific morphogenesis, as a result of joint
initiation and escalation of alcohol intoxication,
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metabolic disorders, organization and dysregeneration
processes. First of all, if there is a strong swelling and
destruction of structural structures in the interstitial
tissue, in addition, due to dysregeneration of
histiocytic cells, their metaplasia into fat cells is
determined. In this case, the histiocytic cells have a
different structure, the cytoplasm of some of them is
strongly eosinophilic, while the cytoplasm of others is
swollen due to the appearance of lipids (Fig. 8). The
cytoplasm of some of them is completely filled with
lipids, so the cytoplasm is wide and the lipid-filled
adiposide is determined.
CONCLUSION
As characteristic changes of alcoholic KMP, a strong
swelling of interstitial tissue and the wall of blood
vessels and around them, as well as growth of
connective tissue are observed. It is determined that
the arterial wall has a different thickness due to the
growth and destruction of the connective tissue. In
some areas of the interstitial tissue of the myocardium,
proliferation and increase of connective tissue cells,
that is, histiocytic cells, among them, metaplasia of
histiocytic cells into fat cells was found. The cytoplasm
of some of them is completely filled with lipids, so it is
determined that they have completely metaplasticized
into the adiposide cells, which have a large cytoplasm
and are full of lipids.
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