Adult atrophy of myocardium

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panmit

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Hello,

I am a little confused on a few world questions that seem contradictory in their explanations. On one question uworld says that with aging, atrophy of myocardium occurs that results in increased interstitial connective tissue, concomitant with extracellular amyloid deposition.

However, in another question where it was discussing hypercalcification of an aortic valve on a normal 75 year old patient, the question asked for what preceded these changes. Uworld answer choice says that in an aging heart valve normal dystrophic calcification occurs and that occurs in the event of cell necrosis. I understand the pathophysiology of that and it makes sense. However, there was also an answer choice that said extracellular amyloid deposition. I figured a normal aging heart valve would have this as well after when i missed the first question. But then the answer explanation said this is only found in amyloidosis.

Can someone help me clear up confusion please
 
Hello,

I am a little confused on a few world questions that seem contradictory in their explanations. On one question uworld says that with aging, atrophy of myocardium occurs that results in increased interstitial connective tissue, concomitant with extracellular amyloid deposition.

However, in another question where it was discussing hypercalcification of an aortic valve on a normal 75 year old patient, the question asked for what preceded these changes. Uworld answer choice says that in an aging heart valve normal dystrophic calcification occurs and that occurs in the event of cell necrosis. I understand the pathophysiology of that and it makes sense. However, there was also an answer choice that said extracellular amyloid deposition. I figured a normal aging heart valve would have this as well after when i missed the first question. But then the answer explanation said this is only found in amyloidosis.

Can someone help me clear up confusion please

Pretty sure they are talking specifically about the valve. Damage to the valvular tissue occurs before calcification (which is what happens in older people with aortic stenosis). Amyloid deposition (from what I understand) is not in the actual valve. It's between the muscle cells.

Someone please correct me if I am wrong.
 
You're right. Amyloid deposition is in the myocardium predominantly. 2 major cases , one from ATTR and one from AL. In older people it is almost always ATTR. It rarely affects the valves directly to cause marked pathology.

Aortic stenosis is almost always caused by calcification. It has nothing to do with amyloid deposition.
 
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