ABC | Volume 110, Nº4, April 2018

Anatomopathological Correlation Nunes et al. A 73 year-old man with ischemic heart disease and cachexia Arq Bras Cardiol. 2018; 110(4):388-392 Figure 5 – Lungs (A and B). Aspiration pneumonia: alveolar spaces filled with dense suppurative neutrophilic inflammatory infiltrate (*), amid which, particulate food material and filamentous bacterial aggregates, morphologically compatible with Actinomyces (arrows), can be seen. Hematoxylin-eosin, 100x (A). 1. OkoshiMP,RomeiroFG,PaivaSA,OkoshiK.Heart failure-inducedcachexia. Arq Bras Cardiol. 2013;100(5):476-82. 2. Pittman JG, Cohen P. The pathogenesis of cardiac cachexia. N Eng J Med. 1964 Aug 27;271:453-60. 3. Rahman A, Jafry S, Jeejeebhoy K, Nagpal AD, Pisani B, Agarwala R. Malnutrition and cachexia in heart failure. JPEN J Parenter Enteral Nutr. 2016;40(4):475-86. 4. Anker SD, Negassa A, Coats AJ, Afzal R, Poole-Wilson PA, Cohn JN, et al. Prognostic importance of weight loss in chronic heart failure and the effect of treatment with angiotensin-converting-enzyme inhibitors: an observational study. Lancet. 2003; 361(9363):1077-83. 5. BuenoCR Jr, Ferreira JC, PereiraMG, BacurauAV, BrumPC. Aerobic exercise training improves skeletal muscle function and Ca2+ handling-related protein expression in sympathetic hyperactivity-induced heart failure. J Appl Physiology (1985). 2010;109(3):702-9. 6. Koene RJ, Prizment AE, Blaes A, Konety SH. Shared risk factors in cardiovascular disease and cancer. Circulation. 2016;133(11):1104-14. 7. Murphy KT. The pathogenesis and treatment of cardiac atrophy in cancer cachexia. Am J Physiol Heart Circ Physiol. 2016;310(4):H466-77. 8. World HealthOrganization. (WHO). Global health estimates 2015: deaths by cause, age and sex, by country and by region, 2000-2015. Geneva; 2016. [Access in 2018 Feb 8]. Available from: http://www.who.int/healthinfo/ global_burden_disease/estimates/en 9. GBD 2013 Mortality and Causes of Death Collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385(9963):117-71. 10. Silver MD, Gotlieb AI, Schoen FJ. (eds.). Cardiovascular pathology. 3 rd ed. New York: Churchill Livingstone; 2001. 11. CabinHS,RobertsWC.True leftventricularaneurysmandhealedmyocardial infarction. Clinical and necropsy observations including quantification of degrees of coronary arterial narrowing. Am J Cardiol. 1980;46(5):754-63. 12. Aronow WS, Ahn C, Kronzon I. Prognosis of congestive heart failure after prior myocardial infarction in older men and women with abnormal versus normal left ventricular ejection fraction. Am J Cardiol. 2000;85(11):1382-4. References This is an open-access article distributed under the terms of the Creative Commons Attribution License preventive measures and the advance in the hemodynamic and pharmacological techniques to treat atherosclerotic disease. Thus, the risk factors for the development of IHD are those for coronary atherosclerosis. This case shows the progression of coronary atherosclerosis and its complications in a male patient with risk factors, such as age (72 years) and systemic arterial hypertension. The atherosclerotic involvement of the coronary arteries, more marked in the AD and CX branches, and the old recanalized thrombus in DA explain the healed transmural infarction in the left ventricular anterior and anterolateral walls and in the ventricular septum, from the heart base to its tip. The complications of myocardial infarction depend on the location and extension of the myocardial necrotic area, which, in our patient, are represented by left ventricular aneurysmal dilation, extensive transmural myocardial fibrosis in the left ventricular anterior wall and organizing thrombus in the endocardium of the infarcted area. An aneurysm can occur early or later after myocardial infarction, 10 and its presence increases the risk for ventricular arrhythmias and CHF. On postmortem exams, aneurysms are found in cases of extensive myocardial infarction and the hearts are enlarged, with hypertrophy of the remaining left ventricular myocardium, left ventricular dilatation and significant luminal obstruction of the major branches of the epicardial coronary arteries. Congestive heart failure is frequent, being the major cause of death. 11 The mortality rate of patients of both sexes, aged at least 70 years, who develop CHF after myocardial infarction and have an abnormal left ventricular ejection fraction, varies from 41% to 92%, respectively, from the first to the fifth post‑infarction year. 12 In the case here discussed, the complication cited contributed to CHF, morphologically identified as anasarca, chronic passive congestion of the lungs, liver and spleen, low cardiac output and cardiac cachexia, determining the patient’s unfavorable outcome. The cause of death was hemodynamic shock, to which CHF and aspiration pneumonia contributed. (Léa Maria Macruz Ferreira Demarchi, MD) 392