Myocardial fibrosis

Jump to navigation Jump to search

Author: Mikael Häggström [note 1]


Fibrosis, in this case an old myocardial infarction of the posterior wall of the left ventricle (seen as pale areas).
Fibrosis consistent with old myocardial infarction, after formalin fixation.

Microscopic evaluation

In case of myocardial fibrosis, attempt to distinguish between the following:

  • Interstitial fibrosis, which is unspecific,[1] (and may simply reported as such).[notes 1]
  • Subepicardial fibrosis, also unspecific (and may simply be reported as such).[notes 2]
  • Replacement fibrosis, which indicates an older infarction.[1]


Example (if uncertain whether there is replacement fibrosis or merely subepicardial fibrosis):

Histopathology of dense fibrous scar replacing myocyte loss in myocardial infarction.jpg
Fibrosis of mainly replacement-type which may indicate an older infarction.


  1. Interstitial fibrosis has been described in congestive heart failure, hypertension, and normal aging. (Chute, 2019)
  2. Subepicardial fibrosis is associated with non-infarction diagnoses such as myocarditis and non-ischemic cardiomyopathy.
    - Gräni, Christoph; Eichhorn, Christian; Bière, Loïc; Kaneko, Kyoichi; Murthy, Venkatesh L.; Agarwal, Vikram; Aghayev, Ayaz; Steigner, Michael; et al. (2019). "Comparison of myocardial fibrosis quantification methods by cardiovascular magnetic resonance imaging for risk stratification of patients with suspected myocarditis ". Journal of Cardiovascular Magnetic Resonance 21 (1). doi:10.1186/s12968-019-0520-0. ISSN 1532-429X. 
    - Bhaskaran, Ashwin; Tung, Roderick; Stevenson, William G.; Kumar, Saurabh (2019). "Catheter Ablation of VT in Non-Ischaemic Cardiomyopathies: Endocardial, Epicardial and Intramural Approaches ". Heart, Lung and Circulation 28 (1): 84–101. doi:10.1016/j.hlc.2018.10.007. ISSN 14439506. 
  1. For a full list of contributors, see article history. Creators of images are attributed at the image description pages, seen by clicking on the images. See Patholines:Authorship for details.

Main page


  1. 1.0 1.1 Chute, Michael; Aujla, Preetinder; Jana, Sayantan; Kassiri, Zamaneh (2019). "The Non-Fibrillar Side of Fibrosis: Contribution of the Basement Membrane, Proteoglycans, and Glycoproteins to Myocardial Fibrosis ". Journal of Cardiovascular Development and Disease 6 (4): 35. doi:10.3390/jcdd6040035. ISSN 2308-3425. 

Image sources