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American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

 

 

 

 

 

 

ABSTRACT 

In hypertrophic cardiomyopathy, the walls of the ventricles of the heart continue with symmetric or asymmetric 

myocardial hypertrophy. Morphologically, in hypertrophic cardiomyopathy, fibrotic foci are detected based on the 

incorrect arrangement of myocardial muscle fibers, small coronary vessel syndrome, and myocardial hypertrophy. 

KEYWORDS 

Heart, cardiomyocyte, hypertrophy, dystrophy, myofibril. 

INTRODUCTION

Cardiomyopathy is a primary damage to the 

myocardium, characterized by inflammation, tumor, 

specific cardiomegaly not related to ischemia, 

worsening heart failure and arrhythmia. It is 

considered an idiopathic (unknown origin) disease of 

the myocardium, which is based on the development 

of dystrophic and sclerotic changes in cardiomyocytes. 

The following types of primary cardiomyopathy are 

distinguished: dilated, hypertrophic, restrictive and 

arrhythmogenic [32,62]. 

Hypertrophic cardiomyopathy is manifested by diffuse 

hypertrophy of one or all parts of the heart, narrowing 

of the ventricles. Hypertrophic cardiomyopathy is 

actually an autosomal dominant disease and occurs 

more often in men of all ages. In hypertrophic 

cardiomyopathy, the ventricular wall continues with 

symmetric or asymmetric hypertrophy of the 

myocardium. Morphologically, in hypertrophic 

cardiomyopathy, fibrotic foci are found on the basis of 

incorrect location of myocardial muscle fibers, 

  Research Article 

 

CHARACTERISTICS OF PATHOMORPHOLOGICAL CHANGES IN 

HYPERTROPHIC CARDIOMYOPATHY 
 

Submission Date: June 20, 2024, Accepted Date:  June 25, 2024,  

Published Date: June 30, 2024  

Crossref doi: https://doi.org/10.37547/ajbspi/Volume04Issue06-10 

 

 

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. 

 

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Volume 04 Issue 06-2024 71 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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"syndrome of small coronary vessels", myocardial 

hypertrophy. The outcome of hypertrophic 

cardiomyopathy is often poor, leading to death from 

heart failure [56,59,104]. 

The purpose of the research: to clarify the specific 

macro- and microscopic changes of the heart in 

hypertrophic 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. 15 

of the 64 identified cases were found to be 

hypertrophic 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 

It was found that the macroscopic appearance of the 

heart in hypertrophic cardiomyopathy consists of the 

following specific changes. The main hypertrophy-like 

changes in the appearance of the heart are observed in 

the left ventricle, where the wall of the left ventricle is 

thickened by an average of 35-45 mm, all the walls of 

the left ventricle are thickened to different degrees, 

the greatest thickening is in the interventricular wall. 

As a result, it was determined that the condition of 

obstruction appeared around the blood outlet of the 

left ventricle of the heart. In 11 of all 15 studied cases, 

the above-mentioned morphological changes and the 

development of an asymmetric form of hypertrophic 

KMP were found. In the rest, it was found that the 

heart was symmetrical, that is, all areas of the left 

ventricle were hypertrophied to the same extent. As a 

characteristic sign of asymmetric hypertrophic KMP, it 

was observed that the wall of the left ventricle was 

mainly thickened in the back and the interventricular 

space, and the difference in wall thickness was 1.2 cm 

on average. Only in some cases (2 cases) was it found 

that the right ventricle of the heart was hypertrophied, 

the orifice of the pulmonary artery narrowed, and 

hypertension of the pulmonary artery developed in 

hypertrophic KMP. 

In hypertrophic cardiomyopathy, the ventricular and 

ventricular spaces have changed to different degrees, 

in most cases, the left ventricle is dilated and 

expanded, there are specific structural changes in the 

mitral valve layers, i.e., they are stretched and 

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Volume 04 Issue 06-2024 72 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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elongated, and their area is increased. In 25% to 65% of 

cases, thickening of the endocardium is detected, 

especially in the upper part of the ventricular septal 

wall, in areas close to the aortic valve. 

Microscopic examination showed that the 

myocardium of almost all patients had a strong 

hypertrophy of cardiomyocytes. In this case, as specific 

microscopic changes, it is observed that the muscle 

fibers are arranged randomly, that is, in the direction of 

different vessels. It is determined that most of the 

myocardial muscle fibers are located in a circle (Fig. 1), 

characteristic tufts of different thickness have 

appeared, and tumor foci have appeared in their cores. 

Fibrous tissue is densely located between the muscle 

bundles consisting of cardiomyocytes, and the fibrous 

bundles are noticeably thick in one place, and relatively 

thin dark hematoxylinous bundles appear in other 

areas. Cardiomyocytes are hypertrophied due to the 

thickening of both myofibrils and sarcoplasm, and their 

nuclei are relatively small and irregular. In other areas 

of the myocardium, it is determined that part of the 

muscle fibers are located longitudinally, and the other 

part is located transversely. It is observed that the 

myofibrils of the cardiomyocytes of the longitudinally 

located muscle fibers are thickened to different 

degrees, the transverse extension lines are lost, and 

the nuclei are pushed aside. It is determined that 

transversely located muscle fibers have different 

thicknesses, some of them are sharply thickened, their 

borders are unclear, and they merge with each other. 

Fibrous tissue and malformed blood vessels are found 

at the junction of muscle fibers in different directions 

(Fig. 2). It is determined that the fibers in the fibrous 

tissue are irregularly arranged, of different 

thicknesses, and blood vessels similar to random 

cracks have appeared between them. 

 In asymmetric forms of hypertrophic KMP, the 

following changes were detected when microscopic 

examination of the upper part of the wall of the 

interventricular space of the heart, that is, the part 

adjacent to the mitral valve. In this area as well, it is 

determined that the myocardial muscle fibers are 

chaotically located, as we can see in the picture, thick 

muscle bundles are visible in cross-section, their 

sarcoplasm is swollen, and myofibrils are thinned and 

sparsely located.  

 

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Volume 04 Issue 06-2024 73 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

Servi 

 

Figure 1. Hypertrophic KMP. It is observed that the muscle fibers are arranged irregularly, and the 

interstitium between them is swollen. Paint: G-E. Floor: 10x40. 

 

 
 

Figure 2. Hypertrophic KMP. Sharply thickened muscle fibers are located both longitudinally and transversely, 

between which fibrous tissue has appeared. Paint: G-E. Floor: 10x40. 

 

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Volume 04 Issue 06-2024 74 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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Figure 3. Hypertrophic KMP. The upper part of the interspinous wall, the muscle bundles are chaotically arranged, 

and relatively thick fibrous tissue has appeared between them. Paint: G-E. Floor: 10x40. 

 

 

Figure 4. Hypertrophic KMP. Sclerosis and thickening of the wall of the coronary arteries located in the myocardial 

intramural. Paint: G-E. Floor: 10x20. 

 

It is observed that other bundles of myocardium are 

located longitudinally and form the outer part of the 

wall of the interventricular space, and myofibrils of 

cardiomyocytes are relatively dense and darkly stained, 

but their histotopography is disturbed due to 

thickening. Between the muscle bundles located in the 

two indicated directions, it is determined that each 

muscle fiber is separated from each other, dense 

fibrous tissue has appeared between them (Fig. 3). 

Fibrous tissue differs from muscle fibers in terms of its 

coloring and composition, it is determined that its 

fibers are densely and irregularly arranged, and its cells 

are relatively numerous and disorderly. 

In hypertrophic KMP, it is determined that there are 

specific morphological changes in the intramural 

coronary arteries of the heart myocardium. In this case, 

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Volume 04 Issue 06-2024 75 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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it is observed that the walls of almost all intramural 

coronary arteries are sclerotized and thickened. The 

larger the diameter of the artery, the more connective 

tissue grows around it and is found to be sclerosed 

(Figure 4). It is determined that the intima of these 

arteries is uneven, the cells in it are hypertrophied and 

hyperchromic, and the basal membrane is also 

thickened. Smooth muscle cells are found to undergo 

both hyperplasia and hypertrophy, and some muscle 

cells are surrounded by fibrous tissue. Due to the 

abundance of fibrous structures in the surrounding 

connective tissue, it is determined that it is densely 

wrapped around the vessel in the form of a ring, as a 

result, the artery cavity is compressed and narrowed. It 

is determined that the walls of relatively small arteries 

and arterioles are thickened due to the growth of the 

connective tissue, which has spread and penetrated 

into the surrounding muscle tissue. 

As another characteristic change of hypertrophic KMP, 

thickening of the endocardium of the left ventricle, 

growth of connective tissue, and sclerosing were 

found in most cases. It is observed that the 

endocardium of the endocardium is atrophied and 

desquamated in some places, migrated, and in other 

areas it is proliferated, increased and thickened. The 

basement membrane beneath the endothelium is 

found to have almost disappeared, disintegrated, and 

merged with the surrounding newly formed 

connective tissue. It is observed that the endocardium 

is thickened in the section (Fig. 5), and even grows 

towards the myocardium adjacent to it. It is 

determined that the connective tissue fibers and cells 

in the endocardium have undergone dystrophy and 

dysregeneration and have changed morphologically. 

Fibrous structures are determined to be shriveled and 

fragmented due to strong swelling in some places, 

relatively pale in color, in other places they are dense, 

homogenized, and destroyed like fibroelastosis and 

hyalinosis. It is found that the cellular composition of 

the endocardial tissue is thinned, their nuclei are 

deformed and hyperchromic. Myocardial muscle fibers 

adjacent to the endocardium are fragmented, 

separated into parts, and most of them are destroyed. 

The destruction of muscle fibers is manifested by the 

loss of the nucleus, the loss of cross-promoting lines in 

myofibrils, their homogenization and myolysis. 

 

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Volume 04 Issue 06-2024 76 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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Figure 5. Hypertrophic KMP. Thickening of the endocardium, elastofibrosis and hyalinosis of connective tissue 

fibers. Paint: G-E. Floor: 10x40. 

 

 

Figure 6. Hypertrophic KMP. Fibromatosis and sclerosis of the endocardium, invasion into the myocardium. Paint: 

G-E. Floor: 10x20. 

Fibromatosis and sclerosis are found in the 

myocardium of the heart in individual cases. It is 

observed that the rough fibrous connective tissue 

completely covers the endocardial layer and has grown 

into the myocardium (Fig. 6). Fibrous tissue contains a 

significant number of fibrous structures with a coarse 

structure, and the intercellular substance has a fine-

grained coarse eosinophilic structure. Fibrous 

structures are chaotically arranged, and in some areas 

dark colored fibrous concretions with a dense and 

coarse texture are found. It is observed that 

connective tissue cells are significantly less than 

fibrous structures, they are randomly located, the 

cytoplasm of most of them is vacuolated and 

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Volume 04 Issue 06-2024 77 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

OCLC – 1121105677     

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Publisher: Oscar Publishing Services 

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expanded. As a result of fibromatosis of the interstitial 

tissue of the myocardium, it is determined that the 

muscle bundles are torn, fragmented and separate 

islands appear, and the cardiomyocytes in these islands 

are destroyed and located in a disorderly manner. 

It should be noted that in most cases of hypertrophic 

KMP, the functional state of the mitral and aortic 

valves is impaired. The morphological basis of these 

functional disorders is definitely the 

pathomorphological changes developed in the 

myocardium and, in addition, the development of 

sclerosis and fibromatosis in both the myocardium and 

the endocardium. The reason is that due to the 

development of fibromatosis in the endocardium, the 

sclerosis process spreads to the layers of the valves, 

causing it to be structurally damaged. In this case, the 

microscopic examinations showed that the myocardial 

tissue adjacent to the layers of the heart valves is 

hypertrophied and thickened, and the connective 

tissue that is part of the valves adjacent to it is fibrosed 

and thickened. It is determined that the fibrous 

structures in the fibrous tissue have multiplied and are 

scattered in this place, on the one hand, they have 

spread to the myocardium, and on the other hand, they 

have deformed the surface of the plate. It is 

determined that the connective tissue cells in the 

fibrous tissue of the cap layer are relatively few, and 

those that are present are vacuolated, hydropic 

dystrophy, and are randomly located. 

CONCLUSION 

In most cases of hypertrophic KMP, an asymmetric 

shape is developed, the wall of the left ventricle is 

mostly thickened in different degrees, the left ventricle 

is dilated in most cases, specific structural changes in 

the layers of the mitral valve, i.e., they are stretched 

and elongated, and their area is increased. In 25% to 65% 

of cases, thickening of the endocardium is detected, 

especially in the upper part of the ventricular septal 

wall, in areas close to the aortic valve. Microscopically, 

this hypertrophic KMP is a typical condition, that is, the 

muscle fibers are located in a chaotic and chaotic 

manner, the connective tissue grows between the 

muscle bundles, the fibrous tissue develops, the 

fibrous tissue often occupies the subendocardial area 

and the endocardium thickens, the fibrous tissue 

spreads to the valvular layers, as a result, it leads to a 

functional violation of the valve. proved. 

REFERENCES 

1. Gudkova A. Ya. Cardiomyopathy. Natsionalnoe 

Rukovodstvo "Cardiology" (short version) pod ed. 

Acad. RAN E.V. Shlyakhto. Izd. "Geotar", Moscow, 

2018. - 815 p. 

2. Sukhacheva T.V., Serov R.A., Bokeria L.A. 

Hypertrophic cardiomyopathy. Ultrastructure of 

cardiomyocytes, spetsificheskie ili stereotypenye 

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3. Shabanova A.T., Haikhai Liang, Yakovleva L.V., 

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Volume 04 Issue 06-2024 78 

                 

 
 

   
  
 

American Journal Of Biomedical Science & Pharmaceutical Innovation    
(ISSN – 2771-2753) 
VOLUME 04 ISSUE 06 PAGES: 70-78 

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Publisher: Oscar Publishing Services 

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hypertrophicheskoy cardiomyopathy // Pediatrics. - 

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Seizer P. Histopathological and Immunological 

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