Diffuse steatosis

Introduction Myocardial steatosis is often the result of severe anemia, hypoxia or infection. Small fat vacuoles appear in the steatotic cardiomyocytes and are arranged in a beaded shape. Visual observation can be performed under the endocardium, especially in the papillary muscles, which are arranged in rows of yellow streaks and dark red normal myocardium, such as tiger skin, so it is called "tiger heart". However, in severe cases of infection or poisoning, it often causes diffuse steatosis in the heart muscle. All myocardium was turbid and grayish yellow, but no streaks were observed.

Cause

Myocardial steatosis, focal myocardial steatosis can be seen in the long-term moderate degree of hypoxia, and the lesions are obvious. Diffuse myocardial steatosis is seen in poisoning and severe hypoxia.

Causes of steatosis:

1. Too much fatty acids entering the liver: such as hunger, diabetes, etc. can cause increased fat mobilization, increased fatty acid intake by liver cells, if it exceeds the liver's ability to oxidize and synthesize lipoproteins, resulting in fat deposition in the liver.

2. Lipoprotein synthesis disorders: When phospholipids or choline deficiency of synthetic lipoproteins are absent, hepatocytes cannot transport lipoproteins and transport them in the liver.

3. Fatty acid oxidative disorders: mitochondria damage during hypoxia, infection, and poisoning, affecting oxidation, leading to a decrease in intracellular ATP production, so that fatty acids entering the liver cells cannot be fully oxidized, and fat is deposited in liver cells.

an examination

Related inspection

Myocardial perfusion imaging, heart sound mapping, dynamic electrocardiogram (Holter monitoring), electrocardiogram anti-myocardial antibody (AMA)

In the case of steatosis, the amount of lipid droplets in the cardiomyocytes is significantly increased. The most prominent sites of myocardial steatosis are the papillary muscles and the subendocardial myocardium. The heavy ones are yellow stripes, the light ones are dark red, and the two are arranged in a phase like tiger skin. Around the veins of the heart and the ventricular papillary muscles and the meat column, grayish yellow stripes or spots are distributed in the normal color myocardium. In the appearance, the appearance is yellow-red and tiger-like markings, so it is called "tiger heart". Light microscopic, bead-like fat vacuoles appear in the myocardium cytoplasm of the fatty degeneration under light microscopy and are arranged between the longitudinal myofibrils.

Differential diagnosis

Identification of myocardial steatosis and hepatic steatosis:

When the liver develops steatosis, it is light, and there is no obvious abnormality in the eye. When it is severe, the liver is swollen, the texture is soft, the color is yellowish to yellow, the structure of the cut surface is fuzzy, there is greasy feeling, and some are even crispy. Microscopically, vacuoles of different sizes appear in the denatured hepatocyte cytoplasm. They are mostly found around the nucleus. Later, they become larger and denser in the whole cytoplasm. In severe cases, they can fuse into a large vacuole. The redemption of the nuclear will become bigger afterwards, and the prize will be like fat cells. If the fatty degeneration of the liver is accompanied by chronic hepatic congestion, the liver section is intertwined with the dark red blood-stained part and the yellow-brown fatty degeneration part, forming a color similar to the Chinese side betel nut cut surface, so it is called "betel nut liver". Frozen slices, lipid droplets can be dyed orange in Sudan. The clinical significance of hepatic steatosis: hepatic steatosis is a reversible injury, and the cause can be restored to normal after elimination. Severe hepatic steatosis is called fatty liver and can cause hepatomegaly, pain and abnormal liver function. Long-term fatty liver can cause liver cell necrosis, fibrosis, and cirrhosis.

Usually the function of the myocardium is not affected, and significant myocardial degeneration is rare today, which is different from myocardial infiltration. Myocardial fat infiltration: Adipose tissue in the pericardial visceral layer is significantly increased, adipose tissue appears in the myocardial interstitial, myocardial atrophy, can cause myocardial rupture, bleeding, sudden death.

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