From Big Medical Encyclopedia

BILIRUBINOVY HEART ATTACK (bilious heart attack) — deposits of bilirubin in a medulla of kidneys of newborns. The term «bilirubinovy heart attack» introduced Klebs for the first time (E. Klebs). The name it does not reflect essence of process; there is no heart attack as the center of a circulator necrosis here. It is more correct to speak about bilirubinovy pigmentation of kidneys of newborns. Disturbances of their function at B. and. are not described. With the naked eye on a section of kidneys in the field of pyramids, especially their nipples, at B. and. radially going orange and reddish strips are visible, during the pressing from them the kashitseobrazny mass of the same color is highlighted. As a rule, all nipples are surprised. Microscopically here deposits of bilirubin in the form of needle, fasciculate or rhombic crystals of ruby-red color, and also in the form of shapeless or granular light yellow deposits are found. The last are located in marrow of kidneys in a gleam of direct tubules and collective tubes, in their epithelium, interstitial fabric and blood vessels.

B. and. arises at concentration of an indirect bilirubin in fie blood less than 30 mg of % and it is observed most often at a kernicterus (see. Hemolitic disease of newborns ), for a cut the high bilirubinemia (20 mg of %) is characteristic. The American authors on section material of an icteric form of a hemolitic disease of newborns with a kernicterus found regarding cases the expressed phenomena of a necrosis in pyramids of kidneys with desquamation of an epithelium of collective tubes, its eosinophilia and pycnosis, and also focuses of necrotic changes of interstitial fabric with leukocytic and fibrinous exudate and with hemorrhages. B.'s cases are described and. without the expressed necrotic changes in pyramids of kidneys, but with the phenomena of their hypostasis. At the same time in a gleam of collective tubes and direct tubules of a pigment is not present, but at B.'s combination and. with urate heart attack (see) deposits of urate salts in a gleam of tubules can accept amber-yellow coloring owing to diffusion of bilirubin. In half of all cases of a kernicterus the indirect bilirubin is found preferential in an interstitium of kidneys, in cytoplasm of histiocytes, vnekletochno, and also in a gleam of vessels. It is proved by positive reaction Wang - den - Berg with spirit extract of nights and negative at water extraction. Except an indirect bilirubin, water-insoluble and not allocated with urine, in kidneys owing to an abnormal liver function also direct bilirubin which at formalin fixing can turn into biliverdin (see is sometimes laid. Bilirubin ).

B. and. often happens an accidental find on opening. Has no independent clinical value, being one of displays of heavy jaundice.

Bibliography: Tabolin V. A. Bilirubinovy exchange and jaundices of newborns, page 223, M., 1967, bibliogr.; Bernstein J. a. L a n d i n g B. H. Extra-neural lesions associated with neonatal hyperbilirubinemia and kernicterus, Amer. J. Path., v. 40, p. 371, 1962; Z u e 1 z e r W. W. a. Brown A. K. Neonatal Jaundice, Amer. J. Dis. Child., v. 101, p. 87, 1961.

BB. B. Gulkevich.