In a 50-year-old man with chronic alcoholism and congestive heart failure, which histologic finding in the myocardium is most likely?

In a 50-year-old man with chronic alcoholism and congestive heart failure, which histologic finding in the myocardium is most likely?

• A. Infiltrates of eosinophils
• B. Foci of cardiac cell necrosis surrounded by neutrophils
• C. Hypertrophy of cardiac myocytes and interstitial fibrosis
• D. Foci of chronic inflammation containing plasma cells and lymphocytes

Answer: (C)

Chronic alcohol exposure with heart failure drives remodeling of the myocardium. The heart compensates for long-standing stress and toxic injury by enlarging the cardiac myocytes (hypertrophy) and by increasing interstitial fibrous tissue (fibrosis). This combination—hypertrophied myocytes with surrounding interstitial fibrosis—reflects the chronic, noninflammatory remodeling seen in alcoholic/dilated cardiomyopathy and explains the reduced contractile function and stiffness typical of long-standing CHF. Infiltrates of eosinophils would suggest eosinophilic myocarditis or Loeffler endocarditis; necrosis with neutrophils points to acute myocardial infarction; chronic inflammation with plasma cells and lymphocytes indicates a chronic inflammatory myocarditis. These do not align with the chronic remodeling pattern described in alcohol-related cardiomyopathy.

Chronic alcohol exposure with heart failure drives remodeling of the myocardium. The heart compensates for long-standing stress and toxic injury by enlarging the cardiac myocytes (hypertrophy) and by increasing interstitial fibrous tissue (fibrosis). This combination—hypertrophied myocytes with surrounding interstitial fibrosis—reflects the chronic, noninflammatory remodeling seen in alcoholic/dilated cardiomyopathy and explains the reduced contractile function and stiffness typical of long-standing CHF.

Infiltrates of eosinophils would suggest eosinophilic myocarditis or Loeffler endocarditis; necrosis with neutrophils points to acute myocardial infarction; chronic inflammation with plasma cells and lymphocytes indicates a chronic inflammatory myocarditis. These do not align with the chronic remodeling pattern described in alcohol-related cardiomyopathy.