Mnemonic

Cardiac Muscle Histology

A memory aid for identifying cardiac muscle microscopically.

Expansion

Branching striated fibres with central nuclei and intercalated discs

Expansion

Identifying features

  • Striated, like skeletal muscle
  • Branching fibres, unlike skeletal muscle
  • One or two central nuclei, in contrast to the peripheral nuclei of skeletal muscle
  • Intercalated discs: dark transverse lines, unique to cardiac muscle
  • Abundant mitochondria, occupying about a third of cell volume
  • Lipofuscin around the nuclei, increasing with age

Intercalated discs contain three junction types, each with a distinct role:

  • Desmosomes and fascia adherens: mechanical coupling, transmitting force
  • Gap junctions: electrical coupling, allowing the myocardium to behave as a functional syncytium

Purkinje fibres are modified cardiac myocytes, appearing larger and paler with abundant glycogen and few myofibrils, located subendocardially.

Pathological appearances: hypertrophy shows enlarged fibres with boxcar nuclei; infarction shows coagulative necrosis with contraction bands after reperfusion; and amyloid appears as interstitial pink material with apple green birefringence on Congo red.

Cardiac muscle is a permanent cell population, which is why infarcted myocardium is replaced by collagenous scar.