Lino Rossi, Andrea Finzi*, Marco Borgioli, Luigi Matturri.
Institute of Pathology, University of Milan, *Institute of Cardiology, Ospedale Maggiore IRCCS, Milan, Italy
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Chronic heart failure is herein intended in its
broadest sense, encompassing an actual and/or potential dysfunctional condition, as well
as its underlying anatomical abnormalities. This semantic liberty is taken by a pathologist to
reassess those changes that determine or contribute to derangements of myocardial
activation-left ventriculary namely-compromising mechanical action.
An inotropic impairment, this one, which can not solely depend on some organic or biochemical
myocardial damage, but also on a disordered spreading and special distribution of ventricular
excitation further which compromises the contractile efficiency of the heart, and thereby the
cardiocirculation performance. Pacemaker management, tentatively suggested a few years ago,
nowadays is gaining therapeutical momentum1-5.
The diverse clinicopathological features of the many diseases that can lead to heart failure are too
well known to need lengthy explanation; it can be enough to herein synthetise the convergence
of manifold morbid aspects into the basic pathophysiologic disorder of pump insufficiency, mainly
occurring in cardiac hypertrophy-dilatation, whatever the underlying cause. And it is commonplace
that, mostly, heart failure results from long-lasting systemic hypertension and/or valvular disease
with the left ventricular hypertrophy attended by coronary-aortic atherosclerosis, with ensuing
myo-cardial fibrosis, up to cardiomyopathic features reminiscent of true cardiomyopathies. Indeed,
both dilated and hypertrophic cardiomyopathies are characterised by a cardiac hypertrophic
components6. This applies also to chronic Chagasic heart disease5 vastly endemic in the South
American subcontinent, but now beginning to spread into the USA.
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