The hearts in all group 1 and 2 patients showed increased size and weight, hypertrophy, and dilation of the left and right atria and ventricles. The myocardium appeared pale and flabby, and endocardium showed punctuate petechial hemorrhages (Figure 4A1). Some patients in group 1 had pathological changes that were related to the patient’s age. These included myocardial ischemic or inflammatory changes, hypertensive changes of the left ventricular cavity, and valvular calcification of the mitral annulus and aortic valve (Figure 4A2).