Question

Which cells in the lungs give rise to heart failure cells?

• A. Macrophages
• B. Lymphocytes
• C. Pneumocytes
• D. Endothelial cells

Hint:

Left-sided heart failure → Pulmonary congestion → RBC leakage → Macrophages engulf RBCs → Hemosiderin-laden macrophages = Heart failure cells.

Answer 1

The Correct Option is A

Step 1: Understanding the Term “Heart Failure Cells”.
Heart failure cells are specialized cells seen in the lungs of patients suffering from chronic left-sided heart failure.
They are not a separate type of cell but are modified alveolar macrophages containing hemosiderin pigment.
They are also called siderophages due to the presence of iron within them.
Step 2: Pathophysiology Behind Their Formation.
In left-sided heart failure, there is increased pressure in the pulmonary veins.
This leads to pulmonary venous congestion.
Due to this increased hydrostatic pressure, red blood cells leak from pulmonary capillaries into the alveolar spaces.
This condition is referred to as pulmonary edema with microhemorrhages.
Step 3: Role of Alveolar Macrophages.
Alveolar macrophages are resident phagocytic cells present within the alveoli.
Their primary function is to remove debris, microorganisms, and extravasated red blood cells.
When RBCs enter the alveoli due to congestion, macrophages engulf these cells by phagocytosis.
Inside the macrophage, hemoglobin is broken down into globin and iron.
The iron component is stored as hemosiderin pigment.
The macrophages containing hemosiderin are called heart failure cells.
Step 4: Histological Appearance.
Microscopically, these cells appear as large macrophages with coarse golden-brown granules in their cytoplasm.
These granules stain positively with Prussian blue stain, confirming the presence of iron.
They are commonly found in sputum samples of patients with chronic congestive heart failure.
Step 5: Evaluation of Other Options.
(A) Macrophages — Correct, as alveolar macrophages ingest RBCs and become hemosiderin-laden.
(B) Lymphocytes — These are immune regulatory cells and do not phagocytose RBCs in this manner.
(C) Pneumocytes — These are epithelial cells responsible for gas exchange and surfactant production.
(D) Endothelial cells — These line blood vessels and are not involved in phagocytosis of RBCs in alveoli.
Step 6: Clinical Significance.
Presence of heart failure cells in sputum indicates chronic pulmonary congestion.
They are a classical feature of long-standing left ventricular failure.
Thus, their origin is directly linked to alveolar macrophages.
Final Conclusion.
Therefore, heart failure cells arise from alveolar macrophages.