Myocardial Biopsy

Myocardial Biopsy



Myocardial biopsy is a procedure wherein a small portion of tissue is removed from the heart muscle for testing. This test is also known as endomyocardial biopsy.


The main reason for a biopsy is to secure tissue samples that will be useful in the diagnosis, treatment, and care of heart muscle disorders. The test is also used to detect rejection after a heart transplantation procedure.


This procedure is not used when the patient is taking blood-thinning medication (anticoagulant therapy). It should not be done when the patient has leukemia and aplastic anemia or if there is a blood clot on the interior wall of the heart.


A long, flexible tube, called a catheter, is inserted into a vein and threaded up into the heart. The doctor can guide the catheter by watching its movement on a TV monitor showing an x-ray image of the area. The tip of the catheter is fitted with tiny jaws that the doctor can open and close. Once the catheter is in place, the doctor will take several small snips of muscle for microscopic examination.


Preparation for myocardial biopsy is quite extensive. The patient will be asked not to eat for several hours before the procedure. A technician will shave the hair from the area of the incision and will also insert an intravenous line in the arm. The patient will be given a sedative to relax but will not be fully anesthetized. The patient will be connected to an electrocardiograph (ECG) to monitor the heart, and a blood-pressure cuff will be placed. Finally, the patient will be covered with sterile drapes, so that the area of the biopsy is kept free of germs. The cardiologist will numb the area where the catheter will be inserted.


At the end of the biopsy, the catheter will be removed and pressure will be applied at the site where it entered the blood vessel in order to encourage healing. The patient will then be taken to the recovery room. It is advisable to remain flat and not to move about for 6-8 hours. After that time, most people begin walking around. Swelling and bruising at the puncture site are common and usually go away without need for further attention.


The risks involved with myocardial biopsy are small because the patient is monitored closely and attended by well-trained staff. Racing of the heart (palpitations) and quivering of the heart muscles (atrial fibrillation) are both possible during the procedure.



American Heart Association. 7320 Greenville Ave. Dallas, TX 75231. (214) 373-6300.

Key terms

Anticoagulant — Medication that thins the blood and slows clot formation.
Aplastic anemia — A greatly decreased production of all of the formed elements of the blood caused by a failure of the cell-generating capacity of the bone marrow.
Electrocardiography — A test that uses electrodes attached to the chest with an adhesive gel to transmit the electrical impulses of the heart muscle to a recording device.
Leukemia — A disease characterized by an increasing number of abnormal cells in the blood.
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This review includes interesting issues and current controversies surrounding the etiology of sarcoidosis, clinical and laboratory manifestations of cardiac sarcoid, gross and microscopic pathology of cardiac sarcoid, utility of the myocardial biopsy, and histologic differential diagnostic considerations of cardiac sarcoid.
Myocardial biopsy, on the other hand, is highly sensitive and specific--especially for anthracycline toxicity, in which common biopsy findings include swelling of the mitochondria and sarcoplasmic reticulum along with my-ocyte disarray.
In addition, myocarditis was another possible diagnosis for this case due to lack of myocardial biopsy.
ECMO was instituted and a right ventricular myocardial biopsy was taken.
A further myocardial biopsy performed three weeks after presentation showed resolving myocardial inflammation with no features of active myocarditis (Figure 2).
Typically coronary angiography demonstrates normal coronary arteries and consequently it is the myocardial biopsy that is diagnostic (6).
This case highlights the difficulties associated with the initial diagnosis of myocarditis, especially in nonspecialist centres where the definitive diagnostic tool of myocardial biopsy is not readily available.
Although myocardial biopsy has been reported to be useful in identifying myocarditis, its role is controversial due to low sensitivity and significant risks associated with the procedure.
Pre- and post-treatment endomyocardial biopsy would have provided more objective findings, but was unnecessary and unethical as myocardial biopsy is not risk free, and both patients improved clinically.
Myocardial biopsy specimens used for pathologic examination, the conventional standard for diagnosis (4,5), have been considered difficult to collect in nonfatal cases.
Pathology reports on autopsy specimens from patients with fatal cases and myocardial biopsy specimens from patients with nonfatal cases were reviewed.
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