Cardiac pathology is the subspecialty of

pathology Pathology is the study of disease. The word ''pathology'' also refers to the study of disease in general, incorporating a wide range of biology research fields and medical practices. However, when used in the context of modern medical treatme ...

which deals with diseases and disorders that affect the

heart The heart is a muscular Organ (biology), organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrie ...

. It encompasses a broad range of conditions, including structural, functional, and biochemical abnormalities that impair the pumping activities of the heart. Cardiac pathology is closely tied to evolution of medical science, autopsy practices and our understanding on cardiovascular system. Major categories of cardiac pathology are congenital heart disease

congenital heart defect A congenital heart defect (CHD), also known as a congenital heart anomaly, congenital cardiovascular malformation, and congenital heart disease, is a defect in the structure of the heart or great vessels that is present at birth. A congenital h ...

, ischemic heart disease

coronary artery disease Coronary artery disease (CAD), also called coronary heart disease (CHD), or ischemic heart disease (IHD), is a type of cardiovascular disease, heart disease involving Ischemia, the reduction of blood flow to the cardiac muscle due to a build-up ...

, hypertensive heart disease,

valvular heart disease Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart). The ...

cardiomyopathy Cardiomyopathy is a group of primary diseases of the heart muscle. Early on there may be few or no symptoms. As the disease worsens, shortness of breath, feeling tired, and swelling of the legs may occur, due to the onset of heart failure. A ...

, inflammatory heart diseases such as

infective endocarditis Infective endocarditis is an infection of the inner surface of the heart (endocardium), usually the heart valve, valves. Signs and symptoms may include fever, petechia, small areas of bleeding into the skin, heart murmur, feeling tired, and anem ...

heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome caused by an impairment in the heart's ability to Cardiac cycle, fill with and pump blood. Although symptoms vary based on which side of the heart is affected, HF ...

arrhythmia Arrhythmias, also known as cardiac arrhythmias, are irregularities in the cardiac cycle, heartbeat, including when it is too fast or too slow. Essentially, this is anything but normal sinus rhythm. A resting heart rate that is too fast – ab ...

, diseases of

pericardium The pericardium (: pericardia), also called pericardial sac, is a double-walled sac containing the heart and the roots of the great vessels. It has two layers, an outer layer made of strong inelastic connective tissue (fibrous pericardium), ...

, neoplastic disorders and other conditions. Major application areas of the knowledge on cardiac pathology are education for health professionals,

autopsy An autopsy (also referred to as post-mortem examination, obduction, necropsy, or autopsia cadaverum) is a surgical procedure that consists of a thorough examination of a corpse by dissection to determine the cause, mode, and manner of deat ...

services, hospital pathology services surgical pathology including heart transplantation.

History of cardiac pathology

The history of cardiac pathology reflects the broader progress in medicine, from ancient misconceptions to modern precision medicine. Today, it remains a dynamic field, integrating cutting-edge research, technology, and clinical insights to advance our understanding and treatment of heart diseases.

Ancient and classical periods

There is a painting of a mammoth with what looks like a red heart in its chest in El Pindal Cave, Spain, dating from 15,000 years ago. Possibly drawn as a target, prehistoric humans understood the heart meant life or death. Ancient Chinese believed the heart was the seat of intelligence and mind. Xin, the ancient Chinese word for heart, was also translated "heart-mind." The heart ruled the body.

Hippocrates Hippocrates of Kos (; ; ), also known as Hippocrates II, was a Greek physician and philosopher of the Classical Greece, classical period who is considered one of the most outstanding figures in the history of medicine. He is traditionally referr ...

(460–370 BCE) recognized the heart as a central organ, but its function was poorly understood. Early physicians believed it played a role in emotions rather than circulation.

Aristotle Aristotle (; 384–322 BC) was an Ancient Greek philosophy, Ancient Greek philosopher and polymath. His writings cover a broad range of subjects spanning the natural sciences, philosophy, linguistics, economics, politics, psychology, a ...

(384–322 BCE) described the heart as the source of heat and life, but his anatomical understanding was limited.

Galen Aelius Galenus or Claudius Galenus (; September 129 – AD), often Anglicization, anglicized as Galen () or Galen of Pergamon, was a Ancient Rome, Roman and Greeks, Greek physician, surgeon, and Philosophy, philosopher. Considered to be one o ...

(129–216 CE) made significant contributions by describing heart chambers and valves, though he misunderstood the circulatory system, believing blood flowed in a two-way system between arteries and veins.

Renaissance and pre-modern period (14th–19th century)

Andreas Vesalius Andries van Wezel (31 December 1514 – 15 October 1564), latinized as Andreas Vesalius (), was an anatomist and physician who wrote '' De Humani Corporis Fabrica Libri Septem'' (''On the fabric of the human body'' ''in seven books''), which is ...

(1514–1564) revolutionized anatomy by performing human dissections and accurately describing the heart's structure, correcting many of Galen's errors.

William Harvey William Harvey (1 April 1578 – 3 June 1657) was an English physician who made influential contributions to anatomy and physiology. He was the first known physician to describe completely, and in detail, pulmonary and systemic circulation ...

(1578–1657) published '' Exercitatio Anatomica de Motu Cordis et Sanguinis in Animalibus'' (''On the Motion of the Heart and Blood''), explaining the systemic circulation of blood and the heart's role as a pump. This was a monumental step in understanding cardiac function.

Giovanni Battista Morgagni Giovanni Battista Morgagni (25 February 1682 – 6 December 1771) was an Italian anatomy, anatomist, generally regarded as the father of modern anatomical pathology, who taught thousands of medical students from many countries during his 56 year ...

(1682–1771), known as the "Father of Modern Pathology", correlated clinical symptoms with postmortem findings, including those related to heart diseases. Matthew Baillie (1761–1823) published the first detailed descriptions of coronary artery disease, aneurysms, and cardiomyopathies in ''The Morbid Anatomy of Some of the Most Important Parts of the Human Body''.

Rudolf Virchow Rudolf Ludwig Carl Virchow ( ; ; 13 October 18215 September 1902) was a German physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician. He is known as "the father of modern pathology" and as the founder o ...

(1821–1902) advanced the field of cellular pathology, linking atherosclerosis and thrombosis to vascular and cardiac diseases.

Discovery of cardiac-specific diseases (19th century)

Understanding of

(CAD) improved with better recognition of

atherosclerosis Atherosclerosis is a pattern of the disease arteriosclerosis, characterized by development of abnormalities called lesions in walls of arteries. This is a chronic inflammatory disease involving many different cell types and is driven by eleva ...

myocardial infarction A myocardial infarction (MI), commonly known as a heart attack, occurs when Ischemia, blood flow decreases or stops in one of the coronary arteries of the heart, causing infarction (tissue death) to the heart muscle. The most common symptom ...

, and

angina Angina, also known as angina pectoris, is chest pain or pressure, usually caused by insufficient blood flow to the heart muscle (myocardium). It is most commonly a symptom of coronary artery disease. Angina is typically the result of parti ...

Valvular heart disease Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart (the aortic and mitral valves on the left side of heart and the pulmonic and tricuspid valves on the right side of heart). The ...

became known, and rheumatic fever and its effects on heart valves were extensively studied. Early classifications of cardiomyopathies began emerging, though their etiology remained unclear.

Technological advances and modern era (20th century)

In 1903, Willem Einthoven developed the first

electrocardiography Electrocardiography is the process of producing an electrocardiogram (ECG or EKG), a recording of the heart's electrical activity through repeated cardiac cycles. It is an electrogram of the heart which is a graph of voltage versus time of t ...

(ECG) device, enabling non-invasive study of heart rhythm and ischemic changes.

Echocardiography Echocardiography, also known as cardiac ultrasound, is the use of ultrasound to examine the heart. It is a type of medical imaging, using standard ultrasound or Doppler ultrasound. The visual image formed using this technique is called an ec ...

(also known as ultrasound) and imaging technologies provided real-time insights into structural and functional cardiac abnormalities. Advances in histopathology arose from improved microscopic techniques, which allowed for detailed examination of myocardial tissue, contributing to the understanding of

myocarditis Myocarditis is inflammation of the cardiac muscle. Myocarditis can progress to inflammatory cardiomyopathy when there is associated ventricular remodeling and cardiac dysfunction due to chronic inflammation. Symptoms can include shortness of bre ...

, and

amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...

Molecular and genetic era (late 20th–21st century)

Molecular pathology Molecular pathology is an emerging discipline within pathology which is focused in the study and diagnosis of disease through the examination of molecules within organs, tissues or bodily fluids. Molecular pathology shares some aspects of practice ...

: The role of genes in cardiac diseases, such as hypertrophic cardiomyopathy and arrhythmogenic cardiomyopathy, became evident. Cardiac markers: Discovery of cardiac-specific biomarkers, like

troponin Troponin, or the troponin complex, is a complex of three regulatory proteins (troponin C, troponin I, and troponin T) that are integral to muscle contraction in skeletal muscle and cardiac muscle, but not smooth muscle. Measurements of cardiac-spe ...

, revolutionized the diagnosis of

. Cardiac Biopsies: Became standard for diagnosing inflammatory and infiltrative conditions, such as

and

sarcoidosis Sarcoidosis (; also known as Besnier–Boeck–Schaumann disease) is a disease involving abnormal collections of White blood cell, inflammatory cells that form lumps known as granulomata. The disease usually begins in the lungs, skin, or lymph n ...

. Postmortem studies through

remain crucial for understanding sudden cardiac death and rare cardiac conditions, while techniques like cardiac MRI and CT provide detailed insights into cardiac pathology without the need for invasive procedures. Genetic testing and personalized therapies have also become integral to diagnosing and managing inherited cardiac disorders.

Cardiac pathology for education

The study of cardiac pathology is critically important subject because it provides medical students and healthcare professionals with the foundational knowledge necessary to understand, diagnose, and manage cardiovascular diseases effectively. Key reasons why this subject is important are as follows; 1. High prevalence of cardiovascular diseases. 2. Integration of basic and clinical sciences. 3. Critical roles in diagnosis. 4. Basis for effective treatment and management.

Cardiac pathology for autopsy

Cardiac pathology and neuropathology are the two most critical part of most autopsy services because

and

brain The brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It consists of nervous tissue and is typically located in the head (cephalization), usually near organs for ...

are the most vital organs of the body. The cardiac pathology in particular is very important at autopsy services because it provides valuable insights into cause of death, underlying conditions, medico-legal implication and

public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the de ...

and

epidemiology Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and Risk factor (epidemiology), determinants of health and disease conditions in a defined population, and application of this knowledge to prevent dise ...

. The coronary

and

are most common life threatening condition of heart and they are primary target of assessment in autopsies for victims of sudden death. Cardiac diseases are closely interrelated that ischemic heart diseases are common in patient with

hypertension Hypertension, also known as high blood pressure, is a Chronic condition, long-term Disease, medical condition in which the blood pressure in the artery, arteries is persistently elevated. High blood pressure usually does not cause symptoms i ...

and

. In those with heart diseases, the left ventricular wall is thick and the myocardial demand for coronary arterial supply is increased. The understanding on the pathogenesis of cardiovascular diseases is invaluable for interpretation of autopsy findings.

Cardiac pathology for hospital pathology services

Cardiac pathology is not a major part of surgical pathology services in hospitals. But there are some critical conditions that cardiac pathology contributes to clinical practices in hospitals. Heart transplantation pathology is an example and histopathological study of endomyocardial biopsy specimens are used to reveal the myocardial condition with acute cellular rejection of antibody mediated rejection. Also the whole heart resected for transplantation is examined to reveal the disease of the failed heart. Diagnostic biopsy for myocardium is often applied when the ventricular contraction is impaired without clear cause.

Amyloidosis Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...

and inflammatory myocardial diseases

are examples. Diseased valve is resected for replacement with artificial valve and pathology confirmed the valvular disease. Cardiac neoplasm is rare but a myxoma is a common cause of primary intracardiac mass. Maligant lesion of intima or intimal

angiosarcoma Angiosarcoma is a rare and aggressive cancer that starts in the endothelial cells that line the walls of blood vessels or lymphatic vessels. Since they are made from Endothelium, vascular lining, they can appear anywhere and at any age, but older ...

also occur as a primary tumor in the heart. Metastatic lesions may occur in the heart, usually at the

References

{{reflist Pathology Cardiovascular system