{"id":2498,"date":"2025-06-12T11:33:56","date_gmt":"2025-06-12T15:33:56","guid":{"rendered":"https:\/\/wordpress.forensicpath.us\/?p=2498"},"modified":"2025-06-12T11:40:31","modified_gmt":"2025-06-12T15:40:31","slug":"pathology-cases-obesity-cardiomyopathy","status":"publish","type":"post","link":"https:\/\/wordpress.forensicpath.us\/index.php\/2025\/06\/12\/pathology-cases-obesity-cardiomyopathy\/","title":{"rendered":"Pathology cases — obesity cardiomyopathy"},"content":{"rendered":"

This is the case of a 33 year old woman who collapsed while walking to the kitchen.\u00a0 At autopsy, she weighed 662 lbs.\u00a0 Her heart weighed 993 grams, and displayed severe 4 chamber dilation.\u00a0 There was pulmonary edema and centrilobular congestion of the liver.\u00a0 Her medical history was remarkable for “obesity hypoventilation syndrome” which I learned as “Pickwickian syndrome” of hypoventilation, chronic hypoxia, and hypercapnia.\u00a0 When I was a medical student, we were taught that this was primarily due to the work of breathing associated with so much chest fat, but nowadays it seems to be multifactorial.<\/p>\n

Here’s a gross photo of the decedent’s heart next to a “more” normal heart of a person who died that day of trauma.\u00a0 Note two things.\u00a0 First, the “more” normal heart is also enlarged — coming in at about 450 grams.\u00a0 It turns out I had three autopsies that day, and all were large people with large hearts.\u00a0 The second thing to notice is that the larger heart looks a bit on the decomposed side.\u00a0 This is often a problem with super morbidly obese folk.\u00a0 \u00a0The large amount of body fat acts as insulation; even if you get the body refrigerated quickly, the internal organs cool so lowly they can show significant decompositional change if the body is in the fridge overnight.<\/p>\n

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Back when I was a student, there was not a specific thing called “obesity cardiomyopathy,” but it seems to be popular now as a diagnosis.\u00a0 As one review notes(1):<\/p>\n

The nomenclature \u201cobesity cardiomyopathy\u201d refers to cardiac morphological, functional, and metabolic abnormalities originating from obesity alone . In some cases, the term \u201cmetabolic cardiomyopathy\u201d may be used in reference to the broad setting of metabolic disorders including insulin resistance, diabetes mellitus, and obesity. In general, long-term obesity is closely associated with cardiac remodeling, characterized as LV hypertrophy, cardiac fibrosis, and diastolic dysfunction that eventually evolves to overt heart failure. [Internal references redacted].<\/em><\/strong><\/p>\n

Here’s a graph of the hazard ratios of cardiomyopathy correlated with BMI from a study of Swedish women:<\/p>\n

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I should also point out that there’s this thing called the “obesity paradox” where people who are obese with heart failure tend to have a lower mortality than matched people without obesity.\u00a0 \u00a0That’s different than getting heart failure in the first place.\u00a0 Some folk have said that the “obesity paradox” is a statistical anomaly due to selection and other biases.\u00a0 I don’t know.<\/p>\n

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  1. Ren, J., Wu, N.N., Wang, S., Sowers, J.R. and Zhang, Y., 2021. Obesity cardiomyopathy: evidence, mechanisms, and therapeutic implications. Physiological reviews, 101(4), pp.1745-1807.<\/li>\n
  2. Robertson J, Lindgren M, Schaufelberger M, Adiels M, Bj\u00f6rck L, Lundberg CE, Sattar N, Rosengren A, \u00c5berg M. Body mass index in young women and risk of cardiomyopathy: a long-term follow-up study in Sweden. Circulation 141: 520\u2013529, 2020. doi:10.1161\/CIRCULATIONAHA.119.044056.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

    This is the case of a 33 year old woman who collapsed while walking to the kitchen.\u00a0 At autopsy, she…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[99,108],"tags":[59,66,28],"class_list":["post-2498","post","type-post","status-publish","format-standard","hentry","category-forensic-pathology","category-gross-pathology","tag-autopsy","tag-heart","tag-pathology"],"_links":{"self":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2498","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/comments?post=2498"}],"version-history":[{"count":3,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2498\/revisions"}],"predecessor-version":[{"id":2503,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/posts\/2498\/revisions\/2503"}],"wp:attachment":[{"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/media?parent=2498"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/categories?post=2498"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/wordpress.forensicpath.us\/index.php\/wp-json\/wp\/v2\/tags?post=2498"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}