Myocardial fibrosis

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Author: Mikael Häggström [notes 1]


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 2]
  • Subepicardial fibrosis, also unspecific (and may simply be reported as such).[notes 3]
  • 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. 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.
  2. Interstitial fibrosis has been described in congestive heart failure, hypertension, and normal aging. (Chute, 2019)
  3. 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. 

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.