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MEDICAL HUMANIT IES

Harv ey B. Simon, MD, Sec tion Editor

A Clos er Look at F rederic Chopin’s Caus e of Death


Mic hał Witt, MD, PhD,a Artur Sz klener, PhD,b J erz y Kawec ki, MD, PhD,c Witold Rużyłło, MD, PhD,d
Marta Negrus z -Kawec ka, MD, PhD,e Mic hał J eleń, MD, PhD,f Renata Langfort, MD, PhD,g Wojc iec h Marc hwic a, PhD,b
T adeus z Dobos z , MD, PhDc
a
Institute ofHuman Genetics,Polish Academy ofSciences,Poznań,Poland; bThe Fryderyk Chopin Institute,Warsaw,Poland; cInstitute of
Forensic Medicine,Wroclaw MedicalUniversity,Wrocław,Poland; dInstitute ofCardiology,Warsaw,Poland; eDepartmentofCardiology;
f
DepartmentofPathomorphology and Oncologic Cytology,Wroclaw MedicalUniversity,Wrocław,Poland; gDepartmentof
Pathomorphology,NationalInstitute ofTuberculosis and Lung Diseases,Warsaw,Poland.

The greatPolish composerand pianistFrederic Chopin was ifnecessary,to undertake a recovery ofthe specimen,itbeing
born in 1810 in Żelazowa Wola nearWarsaw and died in Paris 69 years since the previous evaluation.
atthe tragically young age of 39 years.Being always frail, The specimen was submerged in a pale amber-colorliquid:
Frederic Chopin’s health started to decline dramatically as It is known from historic sources that it could have been
early as 1838.Over the nextyears,he became progressive- cognac,traditionally being used fortissue preservation since
ly more debilitated and less active as a composer,performer, the time of the French Revolution.
and teacher. The entire surface of the heart was covered with a fine,
The issue of which chronically progressive,debilitating whitish,massive fibrillary coating (“frosted heart” image);
disease led to the death ofthe composerstillremains dispu- loose precipitates ofthe coating were visible in the fluid sur-
table;the autopsy record was lost,and only anecdotalreports rounding the specimen.The most prominent lesions found
are available.Hypotheses pointmainly to tubercular infec- were 3 smallnodules,between severalmillimeters up to 1 cm
tion; however, several other diagnostic options have been in diameter,of white-glass appearance,2 on an upper part
considered, including cystic fibrosis,1 alpha-1 antitrypsin of the ventricle and 1 justnear the apex,mostlikely of tu-
deficiency,2 and mitralstenosis.3 They allshare,to an extent, berculous origin (Figure A).Alternatively, similar foci of
common symptoms such as persistentcough,dyspnea,and hyalinization might be of fungal or granulomatous/sarcoid
generalweakness,butlymph gland swelling,hemoptysis,and provenance.
laryngealinvolvementmake the formermostlikely.4 Ofnote,
tuberculosis was endemic in Northern Europe in the 19th
century,with 90% of the population affected by the age of
18 years and one third of the population succumbing to it.5
Chopin was buried in Paris,butaccording to his will(it
is known thathe was obsessively afraid ofbeing buried alive),
his heartwas removed during the autopsy,transported by his
sister in a glass jar to Warsaw,and after multiple historical
perturbations,deposited finally in 1945 in the cryptatthe Holy
Cross Church in Warsaw,6 resting there to this day and being
treated by his compatriots as a nationalrelic ofutmostemo-
tionalvalue.
On April2014,an inspection of the cryptwith Chopin’s
heartwas performed to evaluate the preservation status and,

Funding:None.
Conflicts ofInterest:None.
Authorship:Allauthors had access to the data and played a role in writing
this manuscript.
Requests forreprints should be addressed to MichałWitt,MD,PhD,In-
stitute of Human Genetics,Polish Academy of Sciences,Strzeszyńska 32, F igure The frontview ofthe Frederick
60-479 Poznań,Poland. Chopin’s heart.
E-mailaddress:michal.witt@igcz.poznan.poland.

0002-9343/$ - see frontmatter © 2018 Published by Elsevier Inc.


https://doi.org/10.1016/j.amjmed.2017.09.039
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212 The American Journalof Medicine,Vol131,No 2,February 2018

Evidently, Chopin’s autopsy was conducted in the so- chronic pericarditis is often accompanied by fibrosis and cal-
called French manner:The heartwas pulled outand cutoff cification,which may lead to constrictive pericarditis.
with an incision running through the corona cordis (aorta and This image ofthe pericardium indicates the possibility of
truncus pulmonalis). Because Chopin’s heart was mas- this rare complication ofthe disease,which is evidenced by
sively enlarged and floppy,the cutline was improperly low massive fibrillary deposits and an absence of any macro-
and destroyed both atria.Hemorrhagic effusions,probably scopically identifiable signs of pericardialcalcification.
as a resultof the presence of a subendocardialbloody fluid, On the basis of this visualanalysis,itcan be stated with
typicalof tuberculous pericarditis,were clearly visible. high probability that Frederic Chopin had long-lasting tu-
The leftventricle had been incised for inspection of the berculosis as the primary disease, which was the cause of
internal structures and the mitral valve,and stitched up af- progressive deterioration of his physical condition and nu-
terward (Figure B). The right ventricle was significantly merous symptoms, mainly from the airways.Tuberculous
enlarged.Rightventricularhypertension (consequentto pul- pericarditis,rapidly progressing within a rathershortperiod
monary hypertension)leading to rightventricularhypertrophy of time,a relatively rare complication of diffuse tuberculo-
and eventually rightventriculardilatation with associated right sis,mighthave been the immediate cause of his death.
atrialhypertension,hypertrophy,or dilatation probably had
occurred.
The generaloutlook ofthe specimen suggested that,in the Referenc es
lastmonths of his life,Frederic Chopin had a serious fibri- 1. Majka L,Gozdzik J,WittM.Cystic fibrosis—a probable cause ofFred-
noid epicarditis embodied by fociofepicardialhyalinization eric Chopin suffering and death.J ApplGenet.2003;44:77-84.
in the leftventricular frontwalland with dilatation,mainly 2. Kuzemko J.Chopin’s illness.J RoyalSoc Med.1994;87:769-772.
3. O’Shea J.Music and Medicine.Oxford:Oxford University Press;1990.
of the rightventricle and rightatrium (cor pulmonale) with
4. NeumayrA.Music & Medicine,Vol.3.Bloomington,IL:Medi-Ed Press;
pronounced features ofchronic heartfailure,predominantly 1997.
of the rightventricle.Itis likely thatpericarditis was a con- 5. AbbottEC.Composers and tuberculosis:the effects on creativity.CMAJ.
sequence of tuberculosis and thus can be diagnosed as 1982;126:534-544.
pericarditis tuberculosa,one ofthe mostlife-threatening com- 6. Sydow BE.Account of Fryderyk Chopin’s Heart at the Church of the
Holy Cross,OriginalHeld atthe Fryderyk Chopin Institute in Warsaw.
plications of tuberculosis with a high mortality rate.7 Fibrin
1951.
deposition on the surface of pericardium—sometimes with 7. MayosiBM.Tuberculosis pericarditis and myocarditis in adults and chil-
fociof hemorrhage—is seen,especially in the subacute and dren.In:SchaafHS,Zumla A,eds.Tuberculosis.A Comprehensive Clinical
early chronic phase (chronic fibrinous pericarditis).Overtime, Reference.Philadelphia,PA:Saunders;2009:351-360.

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