Why is there a need for a document on the pathologic diagnosis of cardiac hypertrophy? This is a very important issue as cardiac hypertrophy could be considered as a cause of death. In clinical autopsies, especially those with complex multiorgan disease, the contribution of heart failure (either left or right sided, or both) to the death of a patient is frequently a matter of discussion. For example, in case of sudden death, when the only finding is increased cardiac mass, the pathologist should search for features which could suggest a possible genetic etiology and eventually advice the families for clinical and genetic counseling. The main challenge is to determine whether these features are physiological or pathological, and if they could represent the substrate for arrhythmogenesis or heart failure. The clinical and forensic pathologists are frequently faced with increased heart weight and heart size, with or without increased wall thickness or chamber dilatation at autopsy. Indication for postmortem genetic testing should be integrated into the multidisciplinary management of sudden cardiac death. If the autopsy is carried out in a general or forensic pathology service without expertise in cardiovascular pathology, the entire heart (or pictures) together with mapped histologic slides should be sent for a second opinion to a pathologist with such an expertise. Although some gross morphologic features can point to a specific diagnosis, systematic histologic analysis, followed by possible immunostaining and transmission electron microscopy, is essential for a final diagnosis. The diagnostic work up implies the search for pressure and volume overload conditions, compensatory hypertrophy, storage and infiltrative disorders, and cardiomyopathies. For these reasons, recommendations have been written on behalf of the Association for European Cardiovascular Pathology. Common terminology and methodology to measure the heart weight, size, and thickness as well as a systematic use of cut off values for normality by age, gender, and body weight and height are needed. Since cardiac hypertrophy may be considered a cause of death at autopsy, its assessment requires a uniform approach.
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