Pathology Spotlight: What becomes of the broken hearted?

Welcome to the first in a series of posts entitled “Pathology Spotlight”,  a new regular feature where we will be sharing content describing interesting specimens from our collection with an emphasis on the patho-physiological process.

Each specimen will be described along with an accessible and understandable description of the underlying disease process that led to the pathological change in the specimen. This should help to understand how pathology develops and give a unique insight into disease itself.

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A broken heart is usually a euphemism, but this specimen is very literally broken: it shows a large incised wound in the left ventricle of the heart, which is the main pumping chamber. This was caused by a bayonet. A note accompanying this specimen states:-

‘ Stabbed by sentry on 24th December 1857 at Dublin. Presented by Dr Home, 2nd Dragoon guards to Sir George Ballingall.’

1024px-Bayonette-p1000740[1]
19th century bayonet, similar to the one that caused the wound.

The left ventricle of the heart is the chamber that pumps blood around the body, and so blood in the left ventricle is at higher pressure than anywhere else. This contrasts with the right ventricle, which only pumps blood the short distance to the lungs; the muscular wall of the left ventricle is thick enough to pump blood with up to five times the pressure developed in the right ventricle. A penetrating stab wound to this thick muscular wall would cause blood to spurt out through the wound at very high pressure. The catastrophic loss of blood, and the subsequent drop in blood pressure it would cause, would lead to rapid death.

Where the bleeding is less, for example if the stab wound was to the right ventricle, and drained into the sac enclosing the heart (the pericardium) the heart is likely to be compressed, since the pericardium is made of fibrous tissue which is inelastic. This dangerous condition is called cardiac tamponade. Stab wounds to the heart have become more common in recent decades. Where the wound is small patients may survive, and this is more likely with rapid transport to hospital, better assessment and resuscitation. In hospital the blood can be drained and the heart wound repaired at open operation before the circulation is re-established.

heart
This image shoes the thickness of the walls of the left and right ventricle.
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