401
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Junttila E, Vaara M, Koskenkari J, Ohtonen P, Karttunen A, Raatikainen P, Ala-Kokko T. Repolarization Abnormalities in Patients with Subarachnoid and Intracerebral Hemorrhage. Anesth Analg 2013; 116:190-7. [DOI: 10.1213/ane.0b013e318270034a] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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402
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Arbour RB. Early Metabolic/Cellular-Level Resuscitation Following Terminal Brain Stem Herniation. AACN Adv Crit Care 2013. [DOI: 10.4037/nci.0b013e31827e3031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Patients with terminal brain stem herniation experience global physiological consequences and represent a challenging population in critical care practice as a result of multiple factors. The first factor is severe depression of consciousness, with resulting compromise in airway stability and lung ventilation. Second, with increasing severity of brain trauma, progressive brain edema, mass effect, herniation syndromes, and subsequent distortion/displacement of the brain stem follow. Third, with progression of intracranial pathophysiology to terminal brain stem herniation, multisystem consequences occur, including dysfunction of the hypothalamic-pituitary axis, depletion of stress hormones, and decreased thyroid hormone bioavailability as well as biphasic cardiovascular state. Cardiovascular dysfunction in phase 1 is a hyperdynamic and hypertensive state characterized by elevated systemic vascular resistance and cardiac contractility. Cardiovascular dysfunction in phase 2 is a hypotensive state characterized by decreased systemic vascular resistance and tissue perfusion. Rapid changes along the continuum of hyperperfusion versus hypoperfusion increase risk of end-organ damage, specifically pulmonary dysfunction from hemodynamic stress and high-flow states as well as ischemic changes consequent to low-flow states. A pronounced inflammatory state occurs, affecting pulmonary function and gas exchange and contributing to hemodynamic instability as a result of additional vasodilatation. Coagulopathy also occurs as a result of consumption of clotting factors as well as dilution of clotting factors and platelets consequent to aggressive crystalloid administration. Each consequence of terminal brain stem injury complicates clinical management within this patient demographic. In general, these multisystem consequences are managed with mechanism-based interventions within the context of caring for the donor’s organs (liver, kidneys, heart, etc.) after death by neurological criteria. These processes begin far earlier in the continuum of injury, at the moment of terminal brain stem herniation. As such, aggressive, mechanism-based care, including hormonal replacement therapy, becomes clinically appropriate before formal brain death declaration to support cardiopulmonary stability following terminal brain stem herniation.
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Affiliation(s)
- Richard B. Arbour
- Richard B. Arbour is Critical Care Clinical Nurse Specialist, Philadelphia, Pennsylvania, and Clinical Adjunct Faculty, La Salle University and Holy Family University, 5928 N 11th St, Philadelphia, PA 19141
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403
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Sidharta SL, Sajeev JK, Nelson AJ, Cooke JC, Worthley MI. Stress-induced cardiomyopathy and possible link to cerebral executive function: a case report. Prim Care Companion CNS Disord 2013; 15:13l01557. [PMID: 24800117 DOI: 10.4088/pcc.13l01557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Samuel L Sidharta
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, Adelaide (Drs Sidharta, Nelson, and Worthley); and Eastern Health, Department of Cardiology, Box Hill Hospital, Victoria (Drs Sajeev and Cooke), Australia
| | - Jithin K Sajeev
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, Adelaide (Drs Sidharta, Nelson, and Worthley); and Eastern Health, Department of Cardiology, Box Hill Hospital, Victoria (Drs Sajeev and Cooke), Australia
| | - Adam J Nelson
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, Adelaide (Drs Sidharta, Nelson, and Worthley); and Eastern Health, Department of Cardiology, Box Hill Hospital, Victoria (Drs Sajeev and Cooke), Australia
| | - Jennifer C Cooke
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, Adelaide (Drs Sidharta, Nelson, and Worthley); and Eastern Health, Department of Cardiology, Box Hill Hospital, Victoria (Drs Sajeev and Cooke), Australia
| | - Matthew I Worthley
- Cardiovascular Research Centre, Department of Medicine, University of Adelaide, Adelaide (Drs Sidharta, Nelson, and Worthley); and Eastern Health, Department of Cardiology, Box Hill Hospital, Victoria (Drs Sajeev and Cooke), Australia
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404
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Talman WT, Lin LH. Sudden death following selective neuronal lesions in the rat nucleus tractus solitarii. Auton Neurosci 2012; 175:9-16. [PMID: 23245583 DOI: 10.1016/j.autneu.2012.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/14/2012] [Accepted: 11/15/2012] [Indexed: 01/29/2023]
Abstract
In efforts to assess baroreflex and cardiovascular responses in rats in which substance P (SP) or catecholamine transmission had been eliminated we studied animals after bilateral injections into the nucleus tractus solitarii (NTS) of SP or stabilized SP (SSP) conjugated to saporin (SP-SAP or SSP-SAP respectively) or SAP conjugated to an antibody to dopamine-β-hydroxylase (anti-DBH-SAP). We found that SP- and SSP-SAP eliminated NTS neurons that expressed the SP neurokinin-1 receptor (NK1R) while anti-DBH-SAP eliminated NTS neurons expressing tyrosine hydroxylase (TH) and DBH. The toxins were selective. Thus SP- or SSP-SAP did not eliminate TH/DBH neurons and anti-DBH-SAP did not eliminate NK1R neurons in the NTS. Each toxin, however, led to chronic lability of arterial blood pressure, diminished baroreflex function, cardiac ventricular irritability, coagulation necrosis of cardiac myocytes and, in some animals, sudden death associated with asystole. However, when TH/DBH neurons were targeted and eliminated by injection of 6-hydroxydopamine (6-OHDA), none of the cardiovascular or cardiac changes occurred. The studies reviewed here reveal that selective lesions of the NTS lead to altered baroreflex control and to cardiac changes that may lead to sudden death. Though the findings could support a role for SP or catecholamines in baroreflex transmission neither is proven in that NK1R colocalizes with glutamate receptors. Thus neurons with both are lost when treated with SP- or SSP-SAP. In addition, loss of catecholamine neurons after treatment with 6-OHDA does not affect cardiovascular control. Thus, the effect of the toxins may depend on an action of SAP independent of the effects of the SAP conjugates on targeted neuronal types.
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Affiliation(s)
- William T Talman
- Department of Neurology, Carver College of Medicine University of Iowa and Veterans Affairs Healthcare System, Iowa City, IA 52242, USA.
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405
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Khush K, Pawlikowska L, Menza R, Goldstein B, Hayden V, Nguyen J, Kim H, Poon A, Sapru A, Matthay M, Kwok P, Young W, Baxter-Lowe L, Zaroff J. Beta-adrenergic receptor polymorphisms and cardiac graft function in potential organ donors. Am J Transplant 2012; 12:3377-86. [PMID: 22994654 PMCID: PMC3513582 DOI: 10.1111/j.1600-6143.2012.04266.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Prior studies have demonstrated associations between beta-adrenergic receptor (βAR) polymorphisms and left ventricular dysfunction-an important cause of allograft nonutilization for transplantation. We hypothesized that βAR polymorphisms predispose donor hearts to LV dysfunction after brain death. A total of 1043 organ donors managed from 2001-2006 were initially studied. The following βAR single nucleotide polymorphisms were genotyped: β1AR 1165C/G (Arg389Gly), β1AR 145A/G (Ser49Gly), β2AR 46G/A (Gly16Arg) and β2AR 79C/G (Gln27Glu). In multivariable regression analyses, the β2AR46 SNP was significantly associated with LV systolic dysfunction, with each minor allele additively decreasing the odds for LV ejection fraction <50%. The β1AR1165 and β2AR46 SNPs were associated with higher dopamine requirement during the donor management period: donors with the GG and AA genotypes had ORs of 2.64 (95% CI 1.52-4.57) and 2.70 (1.07-2.74) respectively for requiring >10 μg/kg/min of dopamine compared to those with the CC and GG genotypes. However, no significant associations were found between βAR SNPs and cardiac dysfunction in 364 donors managed from 2007-2008, perhaps due to changes in donor management, lack of power in this validation cohort, or the absence of a true association. βAR polymorphisms may be associated with cardiac dysfunction after brain death, but these relationships require further study in independent donor cohorts.
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Affiliation(s)
- K.K. Khush
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - L. Pawlikowska
- Department of Anesthesia and Perioperative Care and Institute for Human Genetics, University of California, San Francisco
| | - R.L. Menza
- Graduate School of Nursing, Midwifery and Health, Victoria University, Wellington, New Zealand
| | - B.A. Goldstein
- Quantitative Sciences Unit, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - V. Hayden
- California Transplant Donor Network, Oakland, California
| | - J. Nguyen
- California Transplant Donor Network, Oakland, California
| | - H. Kim
- Departments of Anesthesia and Perioperative Care, and Epidemiology and Biostatistics, Institute for Human Genetics, University of California, San Francisco
| | - A. Poon
- Cardiovascular Research Institute, University of California, San Francisco
| | - A. Sapru
- Department of Pediatrics, University of California, San Francisco
| | - M.A. Matthay
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of California, San Francisco
| | - P.Y. Kwok
- Cardiovascular Research Institute and Institute for Human Genetics, University of California, San Francisco
| | - W.L. Young
- Department of Anesthesia and Perioperative Care, University of California, San Francisco
| | - L.A. Baxter-Lowe
- Immunogenetics and Transplantation Laboratory, University of California, San Francisco
| | - J.G. Zaroff
- Kaiser Northern California Division of Research, Oakland, California
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406
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Turillazzi E, Bello S, Neri M, Riezzo I, Fineschi V. Colloid cyst of the third ventricle, hypothalamus, and heart: a dangerous link for sudden death. Diagn Pathol 2012; 7:144. [PMID: 23078815 PMCID: PMC3502434 DOI: 10.1186/1746-1596-7-144] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Colloid cysts are rare congenital, intracranial neoplasms, commonly located in the third ventricle. Colloid cysts are endodermal congenital malformations. The cysts commonly range in size from 1-2 cm in diameter, although large cysts >3 cm in size have been reported. The components of the cyst include an outer fibrous capsule over an inner epithelium. The epithelium is usually a single layer of mucin-producing or ciliated cells. Such cysts contain mucoid and gelatinous material, which is positive for both Periodic acid Schiff (PAS) and mucicarmen staining. Although colloid cysts usually represent histopathologically benign neoplasms, they can result in sudden, unexpected and potentially lethal complications. The mechanism(s) of death is still a controversial subject and several mechanisms have been postulated to explain the sudden onset of severe symptoms and of fatal rapid deterioration in patients with colloid cysts. In this case, macroscopic and histological findings addressed the diagnosis of colloid cyst of the third ventricle with diffuse myocardial injury (coagulative myocytolysis or contraction band necrosis, CBN) and led us to conclude that acute cardiac arrest due to hypothalamus stimulation in the context of colloid cyst of the third ventricle was the cause of death. As the hypothalamic structures which are involved in neuroendocrine and autonomic regulation playing a key role in cardiovascular control are located close to the walls of the third ventricle which is the most frequent anatomical site of colloid cyst, this may suggest that reflex cardiac effects due to the compression of the hypothalamic cardiovascular regulatory centers by the cyst explain the sudden death in patients harboring a colloid cyst when signs of hydrocephalus or brain herniation are lacking. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4915842848034158.
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407
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Y-Hassan S. Insights into the pathogenesis of takotsubo syndrome, which with persuasive reasons should be regarded as an acute cardiac sympathetic disease entity. ISRN CARDIOLOGY 2012; 2012:593735. [PMID: 23119184 PMCID: PMC3478743 DOI: 10.5402/2012/593735] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 09/19/2012] [Indexed: 12/15/2022]
Abstract
The pathogenesis of takotsubo syndrome (TS) has not been established yet. The literature data dealing with the pathogenesis of TS are abundant but scattered among different medical specialities. Subarachnoid hemorrhage and other acute intracranial diseases and injuries are among the important and currently well-recognized trigger factors for TS. In both induced and spontaneous subarachnoid hemorrhages, signs suggestive of increased cardiac sympathetic overactivity have been documented. Surgical and pharmacological sympathectomy has shown to have protective cardiac effects in both animal and human studies. Increase in local release of norepinephrine from the heart of patients with TS has been measured. Signs of both cardiac sympathetic denervation and myocardial lesions adjacent to the cardiac nerve terminals have been seen. Furthermore, the systematized and typically circumferential pattern of ventricular wall motion abnormality is incongruent with the coronary artery supply region and appears most likely to follow the cardiac sympathetic nerve distribution. In conclusion, compelling literature data support the hypothesis that acute cardiac sympathetic disruption and norepinephrine seethe and spillover is causing TS in predisposed patients. TS is most probably an acute cardiac sympathetic disease entity causing myocardial stunning in which takotsubo is one among other cardiac image study findings.
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Affiliation(s)
- Shams Y-Hassan
- Department of Cardiology, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
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408
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Abstract
The cardiac complications of certain neurologic diseases have been well recognized for over 50 years and are mostly evident for cerebrovascular accidents. Although these complications are frequent and in most circumstances benign, detrimental cardiac side effects, such as serious arrhythmias and myocardial infarctions, may occur. The link to most of these cardiac derangements is a transient or chronic autonomic dysfunction, depending on the specific neurologic disease. Myocardial infarcts, left ventricular dysfunction, and arrhythmias are well-recognized complications of subarachnoid hemorrhage, intracranial bleed, and ischemic strokes. Seizures may present with atonia or sudden death from asystole. Degenerative brain disorders, namely the synucleinopathies, may affect the central control areas or peripheral ganglia of the autonomic nervous system, causing autonomic dysfunction. In addition, cardiac conduction defects and cardiomyopathy are common in certain neuromuscular disorders, namely the dystrophies and mitochondrial myopathies.
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409
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Abstract
Many case reports have been published of reversible left ventricular dysfunction precipitated by sudden emotional stress. We have evaluated 10 women hospitalized for acute chest pain and dyspnea, mimicking an acute coronary syndrome, after a severe emotional trigger. Those patients, postmenopausal women, presented ST segment alterations on the EKG, minor elevations of cardiac enzymes, and biomarkers levels. At the coronarography there was not coronary thrombosis or severe stenosis, but the ventriculography showed wall motion abnormalities involving the left ventricular apex and midventricle, in the absence of significant obstructive coronary disease. The course was benign without complication, with a full recovery of left ventricular function in some weeks. These observations, like other reports, demonstrate the impact of emotional stress on left ventricular function and the risk of cardiovascular disease. The cause of this cardiomyopathy is still unknown, and several mechanisms have been proposed: catecholamine myocardial damage, microvascular spasm, or neural mediated myocardial stunning.
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410
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Zhou K, Wu G, Li Y, Zhao L, Zhou R, Zhu Q, Huang X, Mu D, Hua Y. Protective effects of indomethacin and dexamethasone in a goat model with intrauterine balloon aortic valvuloplasty. J Biomed Sci 2012; 19:74. [PMID: 22889399 PMCID: PMC3438018 DOI: 10.1186/1423-0127-19-74] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2012] [Accepted: 07/31/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrauterine balloon aortic valvuloplasty (IUBAV) has been used for critical aortic stenosis. However, it is necessary to determine the fetal impairments such as preterm birth after this approach and to find a way to prevent or reduce them. METHODS In the present study, we evaluated the therapeutic value of indomethacin (IDM) and dexamethasone (DXS) on reducing the preterm birth rate in experimental goats after IUBAV. RESULTS Our results indicated that the administration of IDM/DXS significantly reduced the rate of premature birth. IDM/DXS treatment led to preservation of myocardial ultrastructure with less damage, and amelioration of the fetal and placental circulation. Furthermore, we found that norepinephrine (NE) level was positively associated with the degree of myocardial damage. IDM/DXS administration led to a significant decrease of operation-induced increase of NE levels, which may be associated with the protective effects of IDM/DXS. Lastly, we found that the administration of IDM/DXS did not induce the risk of ductus arteriosus closure or slow down fetal growth. CONCLUSIONS Our results indicate that IDM/DXS promotes a better gestational outcome at least partially by reducing stress response during and after the operation of IUBAV in the goat model. IDM/DXS may be a useful application in human patients during IUBAV intervention.
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Affiliation(s)
- Kaiyu Zhou
- Department of Pediatric Cardiology, Second University Hospital and West China Medical School, Sichuan University, Chengdu 610041, China
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411
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Takotsubo cardiomyopathy, mental stress and the Kounis syndrome. Int J Cardiol 2012; 161:65-7. [PMID: 22882962 DOI: 10.1016/j.ijcard.2012.07.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 07/21/2012] [Indexed: 11/21/2022]
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412
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Burns JD, Green DM, Metivier K, DeFusco C. Intensive Care Management of Acute Ischemic Stroke. Emerg Med Clin North Am 2012; 30:713-44. [DOI: 10.1016/j.emc.2012.05.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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413
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Abstract
This review arose from a talk entitled "Identifying Targets" and given by the author at EB2011 at the invitation of the American Federation for Medical Research (AFMR). The presentation was part of the American Federation for Medical Research workshop entitled "Keys for Translation: Science and Strategy" and focused on identifying clinically relevant targets as a result of observations made during basic scientific studies. The review emphasizes that targets do not have to be the aim that drives basic discovery, but communication between the basic scientist and clinical investigators may aid recognition of such targets and their translation to clinical applications. Using one line of investigator-initiated research from his own laboratory as an example, the author emphasizes that basic discovery must be hypothesis driven and allowed to follow its logical sequence. Finding treatments, while always an aim of biomedical research, may arise as a result of basic studies that were not originally aimed at a target of translational research.
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Affiliation(s)
- William T Talman
- Laboratory of Neurobiology, Department of Neurology, Carver College of Medicine, University of Iowa, Iowa City, IA 52242, USA.
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414
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Toledo E, Lebel A, Becerra L, Minster A, Linnman C, Maleki N, Dodick DW, Borsook D. The young brain and concussion: imaging as a biomarker for diagnosis and prognosis. Neurosci Biobehav Rev 2012; 36:1510-31. [PMID: 22476089 PMCID: PMC3372677 DOI: 10.1016/j.neubiorev.2012.03.007] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/15/2012] [Accepted: 03/21/2012] [Indexed: 01/20/2023]
Abstract
Concussion (mild traumatic brain injury (mTBI)) is a significant pediatric public health concern. Despite increased awareness, a comprehensive understanding of the acute and chronic effects of concussion on central nervous system structure and function remains incomplete. Here we review the definition, epidemiology, and sequelae of concussion within the developing brain, during childhood and adolescence, with current data derived from studies of pathophysiology and neuroimaging. These findings may contribute to a better understanding of the neurological consequences of traumatic brain injuries, which in turn, may lead to the development of brain biomarkers to improve identification, management and prognosis of pediatric patients suffering from concussion.
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Affiliation(s)
- Esteban Toledo
- Center for Pain and the Brain, Children's Hospital Boston, Harvard Medical School, United States
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415
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Pereira VH, Cerqueira JJ, Palha JA, Sousa N. Stressed brain, diseased heart: a review on the pathophysiologic mechanisms of neurocardiology. Int J Cardiol 2012; 166:30-7. [PMID: 22521375 DOI: 10.1016/j.ijcard.2012.03.165] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 01/23/2012] [Accepted: 03/25/2012] [Indexed: 11/25/2022]
Abstract
Cardiovascular diseases are traditionally related to well known risk factors like dyslipidemia, smoking, diabetes and hypertension. More recently, stress, anxiety and depression have been proposed as risk factors for cardiovascular diseases including heart failure, ischemic disease, hypertension and arrhythmias. Interestingly, this association has been established largely on the basis of epidemiological data, due to insufficient knowledge on the underlying pathophysiologic mechanisms. This review will revisit evidence on the interaction between the cardiovascular and nervous systems, highlighting the perspective on how the central nervous system is involved in the pathogenesis of cardiovascular diseases. Such knowledge is likely to be of relevance for the development of better strategies to treat patients in a holistic perspective.
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Affiliation(s)
- Vitor Hugo Pereira
- Life and Health Sciences Research Institute (ICVS), School of Health Sciences, University of Minho, Braga, Portugal
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416
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Hasić S, Jadrić R, Cosović E, Kiseljaković E, Mornjaković Z, Winterhalter-Jadrić M. Heart-type fatty acid-binding protein and its relation with morphological changes in rat myocardial damage model induced by isoproterenol. Bosn J Basic Med Sci 2012; 11:240-4. [PMID: 22117831 DOI: 10.17305/bjbms.2011.2557] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We have investigated heart type fatty acid binding protein (H-FABP) rat serum values at different time point following subcutaneous (s.c) isoproterenol (ISO) administration and their correlation with severity of myocardial lesion. Thirty adult, male, Wistar rats were used for this study. Six rats per group were treated with a single dose of either ISO (ISO groups, dose 100 mg/kg, s.c.) at different time point (30', 60', 120', 240') or with saline (control group). Serum H-FABP was determined by enzyme-linked immunosorbent assay (ELISA) and histological analysis was performed by hematoxylin-eosin (HE) method of staining. The first serum H-FABP increase was obtained 30' following ISO administration, but maximal value was reached after 240'. Myocardial histological changes were time-dependent and correlated with serum H-FABP values (p<0.001). The results of the study suggest that H-FABP is sensitive marker for acute rat myocardial injury and its possible inclusion in myocardial injury screening studies in rats.
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Affiliation(s)
- Sabaheta Hasić
- Department of Medical Biochemistry, Faculty of Medicine, University of Sarajevo, Bosnia and Herzegovina.
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417
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ST-segment elevation and minimally reactive pupils. J Gen Intern Med 2012; 27:478-9. [PMID: 21935754 PMCID: PMC3304042 DOI: 10.1007/s11606-011-1847-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 07/28/2011] [Accepted: 08/15/2011] [Indexed: 10/17/2022]
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418
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“Shishi odoshi aortitis” after aneurismal subarachnoid hemorrhage. Crit Care Med 2012; 40:340-2. [DOI: 10.1097/ccm.0b013e318232d32d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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419
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Park J, Shin JH, Kim SH, Lim YH, Lee JU, Kim KS, Kim SK, Kim JH, Lim HK, Shin J. Type 2 myocardial infarction following generalized tonic-clonic seizure. Korean Circ J 2011; 41:681-4. [PMID: 22194766 PMCID: PMC3242026 DOI: 10.4070/kcj.2011.41.11.681] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 11/11/2010] [Accepted: 01/11/2011] [Indexed: 11/11/2022] Open
Abstract
Myocardial infarction is diagnosed when blood levels of biomarkers are increased in the clinical setting of acute myocardial ischemia. Among the biomarkers, troponin I is the preferred biomarker indicative of myocardial necrosis. It is tissue specific for the heart. Myocardial infarction is rarely reported following seizure. We report a case of elevated troponin I in a patient after an episode of generalized tonic-clonic seizure. The diagnosis was type 2 myocardial infarction.
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Affiliation(s)
- Jinkyu Park
- Division of Cardiology, Department of Internal Medicine, Hanyang University Medical Center, Seoul, Korea
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420
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Summers MR, Madhavan M, Chokka RG, Rabinstein AA, Prasad A. Coincidence of apical ballooning syndrome (tako-tsubo/stress cardiomyopathy) and posterior reversible encephalopathy syndrome: potential common substrate and pathophysiology? J Card Fail 2011; 18:120-5. [PMID: 22300779 DOI: 10.1016/j.cardfail.2011.10.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/09/2011] [Accepted: 10/13/2011] [Indexed: 11/17/2022]
Abstract
BACKGROUND Apical ballooning syndrome (ABS) and posterior reversible encephalopathy syndrome (PRES) are recently described, seemingly unrelated, reversible conditions. The precise pathophysiology of these syndromes remains unknown. The aim of this study was to describe the clinical characteristics and outcomes of a unique series of patients with both ABS and PRES. METHODS AND RESULTS In a retrospective study of 224 consecutive patients diagnosed with ABS between 2002 and 2010, 6 (2.7%) were also diagnosed with PRES. All were female with a mean age of 63.7 ± 12.5 years. All patients had preceding medical comorbidities and physical stress triggers that precipitated ABS and PRES. Mean peak troponin T levels and left ventricular ejection fraction at presentation were 0.47 ± 0.48 mg/dL and 31.5 ± 8.2%, respectively. Characteristic left ventricular wall motion abnormalities (regional wall motion score index 2.22 ± 0.37) were noted in all patients, and magnetic resonance imaging of the brain was significant for vasogenic edema, predominantly in the posterior circulation. All patients recovered left ventricular (ejection fraction at follow-up 60.2 ± 6.0%) and neurologic function with supportive management. Two patients had recurrence of ABS and 1 of PRES during follow-up. CONCLUSIONS ABS and PRES can occur simultaneously during an acute illness. Patients with ABS who develop neurologic dysfunction should be evaluated for PRES and vice versa. Because transient sympathetic overactivity and microvascular dysfunction have been observed in both reversible syndromes, we speculate that they may represent the shared pathophysiologic mechanism.
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Affiliation(s)
- Matthew R Summers
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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421
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Patil H, Vaidya O, Bogart D. A review of causes and systemic approach to cardiac troponin elevation. Clin Cardiol 2011; 34:723-8. [PMID: 22120679 DOI: 10.1002/clc.20983] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2011] [Revised: 08/31/2011] [Indexed: 01/06/2023] Open
Abstract
The first American College of Cardiology/European Society of Cardiology task force published recommendations for a universal definition of myocardial infarction (MI) in 2000 based on the measurement of troponin (Tn). Although this rapid and highly sensitive blood test is certainly valuable in the appropriate setting, its widespread use in variety of clinical scenarios may lead to the detection of Tn elevation in absence of thrombotic acute coronary syndrome. In 2007, the joint European Society of Cardiology/American College of Cardiology Foundation/American Heart Association/World Heart Federation task force proposed a new definition for acute MI based on detection of Tn and associated clinical evidence. The goal of this article is to review the universal definition of acute MI and to differentiate type 1 MI, type 2 MI, and non-acute coronary syndrome Tn elevations. The prognosis and a clinical approach to this differential diagnosis will be developed.
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Affiliation(s)
- Harshal Patil
- Department of Internal Medicine, University of Missouri, Kansas City, Missouri 64108, USA.
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422
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Vergouwen MD, Fang J, Casaubon LK, Stamplecoski M, Robertson A, Kapral MK, Silver FL. Higher Incidence of In-Hospital Complications in Patients With Clipped Versus Coiled Ruptured Intracranial Aneurysms. Stroke 2011; 42:3093-8. [DOI: 10.1161/strokeaha.111.619510] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Mervyn D.I. Vergouwen
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Jiming Fang
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Leanne K. Casaubon
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Melissa Stamplecoski
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Annette Robertson
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Moira K. Kapral
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
| | - Frank L. Silver
- From the Department of Medicine, Division of Neurology (M.D.I.V., L.K.C., F.L.S.) and Division of General Internal Medicine and Clinical Epidemiology and Women's Health Program (M.K.K.), University Health Network, University of Toronto, Toronto, Canada; Utrecht Stroke Center, Department of Neurology and Neurosurgery (M.D.I.V.), University Medical Center Utrecht, Utrecht, the Netherlands; the Department of Health Policy, Management and Evaluation (M.K.K.), University of Toronto, Toronto, Canada; the
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423
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Silvester NC, George CH. Searching for new cardiovascular drugs: towards improved systems for drug screening? Expert Opin Drug Discov 2011; 6:1155-70. [PMID: 22646984 DOI: 10.1517/17460441.2011.625652] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION The pharmaceutical industry urgently needs new ways of profiling the safety and efficacy of new cardiovascular (CV) drugs and more effectively transitioning these compounds through the stages of CV drug screening. This article reviews new technologies and methodological innovations and assesses whether these frameworks offer improved solutions to the problems facing the contemporary CV drug development. AREAS COVERED The article comprises literature derived from a systematic search (from 2000 onwards) using the US patent office and ESP@CENET search engines as well as through multiple Boolean terms. The article focuses on patents relating to technologies and resources and categorises the patents according to their niche in the CV drug screening landscape. EXPERT OPINION The CV drug pipeline is stalling due to the inability of many contemporary drug screening frameworks to discriminate between safe, efficacious therapy and hazardous off-target effect. Given the current limitations of drug screening frameworks, there is little scope for expanding the CV drug portfolio with newer, safer drugs with improved mechanisms of action. New screening modalities are urgently needed. Searches reveal that there are few examples of truly new technologies and systems in the patent literature. This apparent failure to revamp facets of the CV drug screening process can only perpetuate the inability of current platforms to improve the CV drug pipeline. Consequently, with few exceptions, there is stagnation in pre-clinical assay design that limits the pharmaceutical industry's ability to search for new drugs in new and more effective ways.
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Affiliation(s)
- Nicole C Silvester
- Cardiff University, Wales Heart Research Institute , School of Medicine, Heath Park, Cardiff, CF14 4XN , UK
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424
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Mitsuma W, Ito M, Kodama M, Takano H, Tomita M, Saito N, Oya H, Sato N, Ohashi S, Kinoshita H, Kazama JJ, Honda T, Endoh H, Aizawa Y. Clinical and cardiac features of patients with subarachnoid haemorrhage presenting with out-of-hospital cardiac arrest. Resuscitation 2011; 82:1294-7. [DOI: 10.1016/j.resuscitation.2011.05.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 04/19/2011] [Accepted: 05/16/2011] [Indexed: 11/15/2022]
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425
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Ye Z, Xie Q, Xi G, Keep RF, Hua Y. Effects of gender on heart injury after intracerebral hemorrhage in rats. ACTA NEUROCHIRURGICA. SUPPLEMENT 2011; 111:119-22. [PMID: 21725741 DOI: 10.1007/978-3-7091-0693-8_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Intracerebral hemorrhage (ICH)-induced brain injury is less in female than in male rats, and estrogen can reduce such injury in males. Myocardial injury occurs after ischemic and hemorrhagic stroke, and the current study investigated the effects of gender on heart injury after ICH in rats. In the first part of the study, male and female rats had an intracerebral injection of 100 μL autologous blood, and sham-operated rats had a needle insertion. In the second part of the study, male rats were treated with 17β-estrodiol or vehicle 2 h after ICH. All rats were then killed after 3 days and heart samples collected for histology and Western blot analysis. ICH caused heart injury, including petechial hemorrhage in male and female rats. To quantify heart stress following ICH, heat shock proteins (HSP) 32 and 27 were measured by Western blot analysis. We found that heart HSP-32 levels were higher in female compared to male rats after ICH (p<0.01), but there was no effect of gender in sham-operated rats (p>0.05), nor were there gender differences in myocardial HSP27 levels. Treatment with 17β-estrodiol increased HSP-32 levels in male ICH rats (p<0.05). In conclusion, an ICH results in heart injury by an unknown mechanism. Gender and estrogen affect the heart response to ICH.
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Affiliation(s)
- Zi Ye
- Department of Neurosurgery, University of Michigan, Ann Arbor, MI, USA
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426
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Abstract
Stress-related cardiomyopathies can be observed in the four following situations: Takotsubo cardiomyopathy or apical ballooning syndrome; acute left ventricular dysfunction associated with subarachnoid hemorrhage; acute left ventricular dysfunction associated with pheochromocytoma and exogenous catecholamine administration; acute left ventricular dysfunction in the critically ill. Cardiac toxicity was mediated more by catecholamines released directly into the heart via neural connection than by those reaching the heart via the bloodstream. The mechanisms underlying the association between this generalized autonomic storm secondary to a life-threatening stress and myocardial toxicity are widely discussed. Takotsubo cardiomyopathy has been reported all over the world and has been acknowledged by the American Heart Association as a form of reversible cardiomyopathy. Four "Mayo Clinic" diagnostic criteria are required for the diagnosis of Takotsubo cardiomyopathy: 1) transient left ventricular wall motion abnormalities involving the apical and/or midventricular myocardial segments with wall motion abnormalities extending beyond a single epicardial coronary artery distribution; 2) absence of obstructive epicardial coronary artery disease that could be responsible for the observed wall motion abnormality; 3) ECG abnormalities, such as transient ST-segment elevation and/or diffuse T wave inversion associated with a slight troponin elevation; and 4) the lack of proven pheochromocytoma and myocarditis. ECG changes and LV dysfunction occur frequently following subarachnoid hemorrhage and ischemic stroke. This entity, referred as neurocardiogenic stunning, was called neurogenic stress-related cardiomyopathy. Stress-related cardiomyopathy has been reported in patients with pheochromocytoma and in patients receiving intravenous exogenous catecholamine administration. The role of a huge increase in endogenous and/or exogenous catecholamine level in critically ill patients (severe sepsis, post cardiac resuscitation, post tachycardia) to explain the onset of myocardial dysfunction was discussed. Further research is needed to understand this complex interaction between heart and brain and to identify risk factors and therapeutic and preventive strategies.
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Affiliation(s)
- Christian Richard
- AP-HP, Hôpital de Bicêtre, service de réanimation médicale, Le Kremlin-Bicêtre, F-94270 France.
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427
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Abstract
Sudden cardiac death (SCD) is a rapid, unexpected death due to cardiac causes. The differential diagnosis includes diseases from all four structural divisions of the heart: the blood vessels, myocardium, valves, and conduction system. Although ischemic heart disease is a common cause of SCD, acute myocardial infarcts and/or coronary thromboses are not always detected and are not required to make the diagnosis of death due to atherosclerotic coronary disease. Some people die suddenly from heart disease with a grossly and microscopically normal heart. Molecular analysis of some of these autopsy-negative, sudden unexplained deaths (SUD) may detect putative cardiac channel mutations. There are three SCD scenarios that are of particular interest to forensic pathologists: sudden cardiac deaths in young athletes, during criminal altercations (homicide by heart attack), and in other hostile environments. In young athletes, most sudden deaths involve cardiac disease and include cardiomyopathies, congenital coronary artery anomalies, myocarditis, and channelopathies. One must, however, consider other causes in these deaths (e.g., commotio cordis, hyperthermia, sickle cell trait). Homicide-by-heart-attack deaths are those in which the cause of death is an acute exacerbation of underlying cardiac disease, however, the manner is homicide because a criminal act triggered the lethal pathologic cascade. A sudden cardiac arrest may occur in hostile locations with resultant trauma (e.g., while driving a motor vehicle). When the event occurs in the bathtub or other body of water, the question of whether the person died naturally from heart disease or unnaturally from trauma (e.g., drowning) often arises. One should not be mislead by the initial physical surroundings of the death (i.e., in a motor vehicle collision, or swimming pool) and fail to distinguish a natural sudden death from an accidental one.
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Affiliation(s)
- James R. Gill
- Department of Forensic Medicine at New York University School of Medicine, New York, New York
| | - Rachel A. Lange
- Department of Forensic Medicine at New York University School of Medicine (RL)
| | - Omar P. Azar
- Department of Pathology at New York University School of Medicine (OA)
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428
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Katan M, Elkind MSV. Inflammatory and neuroendocrine biomarkers of prognosis after ischemic stroke. Expert Rev Neurother 2011; 11:225-39. [PMID: 21306210 DOI: 10.1586/ern.10.200] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Stroke is the third leading cause of mortality in the USA and one of the leading causes of severe morbidity. It is important to provide stroke patients and physicians with the most accurate prognostic information to optimize care and allocation of healthcare resources. Reliable prognostic markers available during the initial phase after acute stroke may aid clinical decision-making. Several interesting candidate biomarkers have been studied to address prognostic questions; this article will focus on selected inflammatory and neuroendocrine markers. The utility of a biomarker is defined by its ability to improve clinical decision-making and add timely information beyond that readily available from clinical examination and routine imaging. This aim has not been completely achieved yet for any biomarkers, but promising data are available and further studies are ongoing.
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Affiliation(s)
- Mira Katan
- Stroke Division, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
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429
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Mazzeo AT, La Monaca E, Di Leo R, Vita G, Santamaria LB. Heart rate variability: a diagnostic and prognostic tool in anesthesia and intensive care. Acta Anaesthesiol Scand 2011; 55:797-811. [PMID: 21658013 DOI: 10.1111/j.1399-6576.2011.02466.x] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The autonomic nervous system (ANS) plays an important role in the human response to various internal and external stimuli, which can modify homeostasis, and exerts a tight control on essential functions such as circulation, respiration, thermoregulation and hormonal secretion. ANS dysfunction may complicate the perioperative course in the surgical patient undergoing anesthesia, increasing morbidity and mortality, and, therefore, it should be considered as an additional risk factor during pre-operative evaluation. Furthermore, ANS dysfunction may complicate the clinical course of critically ill patients admitted to intensive care units, in the case of trauma, sepsis, neurologic disorders and cardiovascular diseases, and its occurrence adversely affects the outcome. In the care of these patients, the assessment of autonomic function may provide useful information concerning pathophysiology, risk stratification, early prognosis prediction and treatment strategies. Given the role of ANS in the maintenance of systemic homeostasis, anesthesiologists and intensivists should recognize as critical the evaluation of ANS function. Measurement of heart rate variability (HRV) is an easily accessible window into autonomic activity. It is a low-cost, non-invasive and simple to perform method reflecting the balance of the ANS regulation of the heart rate and offers the opportunity to detect the presence of autonomic neuropathy complicating several illnesses. The present review provides anesthesiologists and intensivists with a comprehensive summary of the possible clinical implications of HRV measurements, suggesting that autonomic dysfunction testing could potentially represent a diagnostic and prognostic tool in the care of patients both in the perioperative setting as well as in the critical care arena.
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Affiliation(s)
- Anna Teresa Mazzeo
- Anaesthesia and NeuroIntensive Care Unit, Department of Neurosciences, Psychiatry and Anaesthesiology, University of Messina, Messina, Italy.
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430
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Leistedt SJJ, Linkowski P, Lanquart JP, Mietus JE, Davis RB, Goldberger AL, Costa MD. Decreased neuroautonomic complexity in men during an acute major depressive episode: analysis of heart rate dynamics. Transl Psychiatry 2011; 1:e27. [PMID: 22832529 PMCID: PMC3309515 DOI: 10.1038/tp.2011.23] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Accepted: 06/01/2011] [Indexed: 11/25/2022] Open
Abstract
Major depression affects multiple physiologic systems. Therefore, analysis of signals that reflect integrated function may be useful in probing dynamical changes in this syndrome. Increasing evidence supports the conceptual framework that complex variability is a marker of healthy, adaptive control mechanisms and that dynamical complexity decreases with aging and disease. We tested the hypothesis that heart rate (HR) dynamics in non-medicated, young to middle-aged males during an acute major depressive episode would exhibit lower complexity compared with healthy counterparts. We analyzed HR time series, a neuroautonomically regulated signal, during sleep, using the multiscale entropy method. Our results show that the complexity of the HR dynamics is significantly lower for depressed than for non-depressed subjects for the entire night (P<0.02) and combined sleep stages 1 and 2 (P<0.02). These findings raise the possibility of using the complexity of physiologic signals as the basis of novel dynamical biomarkers of depression.
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Affiliation(s)
- S J-J Leistedt
- Sleep Laboratory, Psychiatric Laboratory Research, Psychiatric Department, Erasme Academic Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - P Linkowski
- Sleep Laboratory, Psychiatric Laboratory Research, Psychiatric Department, Erasme Academic Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - J-P Lanquart
- Sleep Laboratory, Psychiatric Laboratory Research, Psychiatric Department, Erasme Academic Hospital, Free University of Brussels (ULB), Brussels, Belgium
| | - J E Mietus
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - R B Davis
- Division of General Medicine Primary Care, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A L Goldberger
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
| | - M D Costa
- Division of Interdisciplinary Medicine and Biotechnology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- The Wyss Institute for Biologically Inspired Engineering at Harvard University, Boston, MA, USA
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431
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Chiu TF, Huang CC, Chen JH, Chen WL. Depressed sympathovagal balance predicts mortality in patients with subarachnoid hemorrhage. Am J Emerg Med 2011; 30:651-6. [PMID: 21570235 DOI: 10.1016/j.ajem.2011.02.037] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2011] [Revised: 02/26/2011] [Accepted: 02/27/2011] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES The objective of this study is to investigate the role of sympathovagal balance in predicting inhospital mortality by assessing power spectral analysis of heart rate variability (HRV) among patients with nontraumatic subarachnoid hemorrhage (SAH) in an emergency department (ED). METHODS A cohort of 132 adult patients with spontaneous SAH in an ED was prospectively enrolled. A continuous 10-minute electrocardiography for off-line power spectral analysis of the HRV was recorded. Using the inhospital mortality, the patients were classified into 2 groups: nonsurvivors (n=38) and survivors (n=94). The HRV measures were compared between these 2 groups of patients. RESULTS Having compared the various measurements, the very low-frequency component, low-frequency component, normalized low-frequency component (LF%), and low-/high-frequency component ratio (LF/HF) were significantly lower, whereas the normalized high-frequency component was significantly higher among the nonsurvivors than among the survivors. A multiple logistic regression model identified LF/HF (odds ratio, 2.16; 95% confidence interval [CI], 1.18-3.97; P=.013) and LF% (odds ratio, 0.78; 95% CI, 0.69-0.88; P<.001) as independent variables that were able to predict inhospital mortality for patients with SAH in an ED. The receiver operating characteristic area for LF/HF in predicting inhospital mortality was 0.957 (95% CI, 0.914-1.000; P<.001), and the best cutoff points was 0.8 (sensitivity, 92.1%; specificity, 90.4%). CONCLUSIONS Power spectral analysis of the HRV is able to predict inhospital mortality for patients after SAH in an ED. A tilt in the sympathovagal balance toward depressed sympathovagal balance, as indicated by HRV analysis, might contribute to the poor outcome among these patients.
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Affiliation(s)
- Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital Linkou Branch, Chang Gung University College of Medicine, Tao-Yuan 333, Taiwan
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432
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Bassino E, Fornero S, Gallo MP, Ramella R, Mahata SK, Tota B, Levi R, Alloatti G. A novel catestatin-induced antiadrenergic mechanism triggered by the endothelial PI3K-eNOS pathway in the myocardium. Cardiovasc Res 2011; 91:617-24. [PMID: 21543385 DOI: 10.1093/cvr/cvr129] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
AIMS Catestatin (CST) is a chromogranin A (CgA)-derived peptide (hCgA352-372) with three identified human variants (G364S/P370L/R374Q-CST) that show differential potencies towards the inhibition of catecholamine release. Although CST affects several cardiovascular parameters, the mechanisms underlying CST action in the heart have remained elusive. Therefore, we sought to determine the mechanism of action of CST and its variants on ventricular myocardium and endothelial cells. METHODS AND RESULTS Contractile force and Ca(2+) transients were measured, respectively, on rat papillary muscles and isolated cardiomyocytes (CC) under basal conditions and after β-adrenergic stimulation. Nitric oxide (NO) production and endothelial nitric oxide synthase (eNOS) phosphorylation (P(Ser1179)eNOS) were studied in bovine aortic endothelial (BAE-1) cells. Under basal conditions, wild-type CST (WT-CST, 10-50 nM) transiently enhanced myocardial contractility. CST variants (G364S and P370L) exerted a comparable positive inotropic effect. The H(1) histamine receptor antagonist mepyramine abolished the increase of contractile force induced by WT-CST. Moreover, WT-CST dose-dependently (5-50 nM) reduced the effect of β-adrenergic stimulation. This anti-adrenergic effect was not mediated by a direct action on CC, but involved a PI3K-dependent NO release from endocardial endothelial cells. Indeed, CST induced a wortmannin-sensitive, Ca(2+)-independent increase in NO production and eNOS phosphorylation on BAE-1 cells. While the anti-adrenergic and NO release effects of P370L-CST were comparable with those of WT-CST, the G364S variant was ineffective on the same parameters. CONCLUSION Our results suggest that the anti-adrenergic action of CST depends on the endothelial PI3K-Akt-eNOS pathway and that its structural alterations entail functional features that correlate with the different anti-hypertensive potential described in humans.
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Affiliation(s)
- Eleonora Bassino
- Department of Animal and Human Biology, University of Turin, via Accademia Albertina, 13, 10123 Turin, Italy
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433
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Neidert S, Katan M, Schuetz P, Fluri F, Ernst A, Bingisser R, Kappos L, Engelter ST, Steck A, Müller B, Christ-Crain M. Anterior pituitary axis hormones and outcome in acute ischaemic stroke. J Intern Med 2011; 269:420-32. [PMID: 21205022 DOI: 10.1111/j.1365-2796.2010.02327.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Early and accurate prediction of outcome in acute stroke is important and influences risk-optimized therapeutic strategies. Endocrine alterations of the hypothalamic-pituitary axis are amongst the first measurable alterations after cerebral ischaemia. We therefore evaluated the prognostic value of cortisol, triiodothyronine (T3), free thyroxine (fT4), thyroid-stimulating hormone (TSH) and growth hormone (GH) in patients with an acute ischaemic stroke. METHODS In an observational study including 281 patients with ischaemic stroke, anterior pituitary axis hormones (i.e. cortisol, T3, fT4, TSH and GH) were simultaneously assessed to determine their value to predict functional outcome and mortality within 90 days and 1 year. RESULTS In receiver operating characteristic curve analysis, the prognostic accuracy of cortisol was higher compared to all measured hormones and was in the range of the National Institutes of Health Stroke Scale (NIHSS). Cortisol was an independent prognostic marker of functional outcome and death [odds ratio (OR) 1.0 (1.0-1.01) and 1.62 (1.37-1.92), respectively, P<0.0002 for both, adjusted for age and the NIHSS] in patients with ischaemic stroke, but added no significant additional predictive value to the clinical NIHSS score. CONCLUSION Cortisol is an independent prognostic marker for death and functional outcome within 90 days and 1 year in patients with ischaemic stroke. By contrast, other anterior pituitary axis hormones such as peripheral thyroid hormones and GH are only of minor value to predict outcome in stroke.
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Affiliation(s)
- S Neidert
- Department of Endocrinology, University Hospital Basel, Basel, Switzerland.
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434
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Kop WJ, Synowski SJ, Newell ME, Schmidt LA, Waldstein SR, Fox NA. Autonomic nervous system reactivity to positive and negative mood induction: the role of acute psychological responses and frontal electrocortical activity. Biol Psychol 2011; 86:230-8. [PMID: 21182891 PMCID: PMC3061260 DOI: 10.1016/j.biopsycho.2010.12.003] [Citation(s) in RCA: 96] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 12/09/2010] [Accepted: 12/10/2010] [Indexed: 11/19/2022]
Abstract
The differential effects of positive versus negative emotions on autonomic nervous system activity are insufficiently understood. This study examined the role of acute mood responses and central nervous system activity on heart rate variability (HRV) using 5-min event recall tasks (happiness and anger recall) and a 5-min Stroop Color Word Test (SCWT) in 20 healthy individuals (mean age 25 ± 4 years, 55% female). HRV was measured in high frequency (HF) and low frequency (LF) domains, and frontal brain activity using electroencephalography (EEG) in the alpha frequency band in F3 and F4. Happiness Recall resulted in increased LF-HRV (p = 0.005) but not HF-HRV (p=0.71). Anger Recall did not change HRV (p-values > 0.10). The SCWT produced decreases in HF-HRV (p = 0.001) as well as LF-HRV (p = 0.001). The magnitude of feeling "happy" during Happiness Recall was positively correlated with ΔHF-HRV (p = 0.050), whereas an incongruent mood state ("frustrated") was associated with smaller ΔHF-HRV (p = 0.070). Associations between frontal EEG activation and HRV responses were mostly non-significant, except for increased right frontal activation during Happiness Recall which was associated with a decrease in LF/HF ratio (p = 0.009). It is concluded that positive and negative mood induction result in differential HRV responses, which is related to both task valence and the intensity of task-induced emotions.
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Affiliation(s)
- Willem J Kop
- Department of Medicine, University of Maryland, Baltimore, MD 21201, USA.
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435
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436
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Transient left ventricular apical ballooning in a patient with cardiac arrest after subarachnoid hemorrhage. J Cardiol Cases 2011; 3:e33-e36. [PMID: 30532830 DOI: 10.1016/j.jccase.2010.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/15/2010] [Accepted: 08/16/2010] [Indexed: 11/21/2022] Open
Abstract
Subarachnoid hemorrhage (SAH) often accompanies cardiac abnormalities. Sudden cardiac arrest is also known to occur after SAH. A 32-year-old woman was admitted to our hospital because of cardiac arrest immediately after the onset of SAH. Return of spontaneous circulation was obtained by conventional advanced cardiovascular life support. After resuscitation, her echocardiogram showed left ventricular apical ballooning, which improved within 7 days. This is the first report presenting both sudden cardiac arrest and transient left ventricular apical ballooning after SAH.
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437
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Nyquist KE, Abramson DW, Huffman JC. Apical ballooning syndrome: the "broken heart" syndrome. PRIMARY CARE COMPANION TO THE JOURNAL OF CLINICAL PSYCHIATRY 2011; 12. [PMID: 21274349 DOI: 10.4088/pcc.10r00949whi] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2010] [Accepted: 07/06/2010] [Indexed: 10/19/2022]
Affiliation(s)
- Kate E Nyquist
- Department of Psychiatry, Massachusetts General Hospital, Boston
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438
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Deferoxamine Affects Heat Shock Protein Expression in Heart after Intracerebral Hemorrhage in Aged Rats. INTRACEREBRAL HEMORRHAGE RESEARCH 2011; 111:197-200. [DOI: 10.1007/978-3-7091-0693-8_33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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439
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Cardin C, Roncalli J, Lairez O, Austruy J, Elbaz M, Carrie D, Galinier M. Subarachnoid haemorrhage associated with midventricular Tako-Tsubo syndrome. Int J Cardiol 2011; 146:e46-8. [DOI: 10.1016/j.ijcard.2009.03.079] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Accepted: 03/15/2009] [Indexed: 11/26/2022]
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440
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Kamran H, Salciccioli L, Lazar JM. Reduced water induced skin wrinkling in congestive heart failure. Clin Auton Res 2010; 21:361-2. [PMID: 21184248 DOI: 10.1007/s10286-010-0109-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
Water immersion skin wrinkling (WISW) of the fingertips may reflect central autonomic function. We found lower WISW in 60 heart failure patients versus controls (1.6±0.67 vs. 2.5±1.1, p<0.001), linking a cardiovascular disorder to reduced WISW.
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441
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Affiliation(s)
- Sitaramesh Emani
- The Ohio State University Division of Cardiovascular Medicine and the Dorothy Davis Heart and Lung Research Institute, 473 W 12th Ave, Columbus, OH 43210-1252, USA
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442
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Tota B, Cerra MC, Gattuso A. Catecholamines, cardiac natriuretic peptides and chromogranin A: evolution and physiopathology of a 'whip-brake' system of the endocrine heart. ACTA ACUST UNITED AC 2010; 213:3081-103. [PMID: 20802109 DOI: 10.1242/jeb.027391] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In the past 50 years, extensive evidence has shown the ability of vertebrate cardiac non-neuronal cells to synthesize and release catecholamines (CA). This formed the mindset behind the search for the intrinsic endocrine heart properties, culminating in 1981 with the discovery of the natriuretic peptides (NP). CA and NP, co-existing in the endocrine secretion granules and acting as major cardiovascular regulators in health and disease, have become of great biomedical relevance for their potent diagnostic and therapeutic use. The concept of the endocrine heart was later enriched by the identification of a growing number of cardiac hormonal substances involved in organ modulation under normal and stress-induced conditions. Recently, chromogranin A (CgA), a major constituent of the secretory granules, and its derived cardio-suppressive and antiadrenergic peptides, vasostatin-1 and catestatin, were shown as new players in this framework, functioning as cardiac counter-regulators in 'zero steady-state error' homeostasis, particularly under intense excitatory stimuli, e.g. CA-induced myocardial stress. Here, we present evidence for the hypothesis that is gaining support, particularly among human cardiologists. The actions of CA, NP and CgA, we argue, may be viewed as a hallmark of the cardiac capacity to organize 'whip-brake' connection-integration processes in spatio-temporal networks. The involvement of the nitric oxide synthase (NOS)/nitric oxide (NO) system in this configuration is discussed. The use of fish and amphibian paradigms will illustrate the ways that incipient endocrine-humoral agents have evolved as components of cardiac molecular loops and important intermediates during evolutionary transitions, or in a distinct phylogenetic lineage, or under stress challenges. This may help to grasp the old evolutionary roots of these intracardiac endocrine/paracrine networks and how they have evolved from relatively less complicated designs. The latter can also be used as an intellectual tool to disentangle the experimental complexity of the mammalian and human endocrine hearts, suggesting future investigational avenues.
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Affiliation(s)
- Bruno Tota
- Department of Cell Biology, University of Calabria, 87030, Arcavacata di Rende, Italy.
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443
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Beissner F. Functional magnetic resonance imaging studies of acupuncture mechanisms: a critique. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.2042-7166.2010.01048.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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444
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Lindsay J, Paixao A, Chao T, Pichard AD. Pathogenesis of the Takotsubo syndrome: a unifying hypothesis. Am J Cardiol 2010; 106:1360-3. [PMID: 21029839 DOI: 10.1016/j.amjcard.2010.06.068] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2010] [Revised: 06/15/2010] [Accepted: 06/15/2010] [Indexed: 02/04/2023]
Abstract
The takotsubo syndrome (TS) is defined by a constellation of clinical observations in a subgroup of patients with acute coronary syndromes. Separating patients with TS from the general population with acute ischemic events are 2 important findings: obstructive coronary artery disease is missing, but the sine qua non is a distinctive pattern of abnormal left ventricular contraction. As with many newly recognized clinical syndromes, TS seems not to conform to accepted pathogenetic mechanisms. Thus, physicians are challenged to identify previously unrecognized mechanisms of disease. Two schools of thought have emerged in this regard. Most consider its pathogenesis to be a stress-induced neurohormonal phenomenon, while a smaller but substantial group believe that the transient occlusion of an epicardial coronary artery is responsible and that the syndrome is simply an unusual manifestation of coronary atherosclerosis. This editorial outlines briefly the evidence for each of these positions and presents a novel construct that may encompass the 2 views. Central to this unifying hypothesis is the belief that a neurohormonal surge triggers the hallmark left ventricular contraction abnormality, the sine qua non of the TS. In conclusion, the authors postulate that this pattern will result regardless of the state of the epicardial coronary arteries and can be observed in patients with angiographically normal coronary arteries, as well as those with obstructed or occluded arteries.
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445
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Beissner F, Henke C, Unschuld PU. Forgotten features of head zones and their relation to diagnostically relevant acupuncture points. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2010; 2011:240653. [PMID: 19141490 PMCID: PMC3135114 DOI: 10.1093/ecam/nen088] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 12/18/2008] [Indexed: 12/14/2022]
Abstract
In the 1890s Sir Henry Head discovered certain areas of the skin that develop tenderness (allodynia) in the course of visceral disease. These areas were later termed "Head zones". In addition, he also emphasized the existence of specific points within these zones, that he called "maximum points", a finding that seems to be almost forgotten today. We hypothesized that two important groups of acupuncture points, the diagnostically relevant Mu and Shu points, spatially and functionally coincide with these maximum points to a large extent. A comparison of Head's papers with the Huang Di Neijing (Yellow Thearch's Inner Classic) and the Zhen Jiu Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion), two of the oldest still extant Chinese sources on acupuncture, revealed astonishing parallels between the two concepts regarding both point locations and functional aspects. These findings suggest that the Chinese discovery of viscerocutaneous reflexes preceded the discovery in the West by more than 2000 years. Furthermore, the fact that Chinese medicine uses Mu and Shu points not only diagnostically but also therapeutically may give us new insights into the underlying mechanisms of acupuncture.
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Affiliation(s)
- Florian Beissner
- Brain Imaging Center, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Frankfurt, Germany
- Institute of Neuroradiology, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Frankfurt, Germany
| | - Christian Henke
- Brain Imaging Center, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Frankfurt, Germany
- Department of Neurology, Goethe-University, Schleusenweg 2-16, 60528 Frankfurt, Frankfurt, Germany
| | - Paul U. Unschuld
- Horst Goertz Institute for Theory, History and Ethics of Chinese Life Sciences, Charité University Medicine, Berlin, Germany
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446
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Perioperative hypothermia (33 degrees C) does not increase the occurrence of cardiovascular events in patients undergoing cerebral aneurysm surgery: findings from the Intraoperative Hypothermia for Aneurysm Surgery Trial. Anesthesiology 2010; 113:327-42. [PMID: 20571361 DOI: 10.1097/aln.0b013e3181dfd4f7] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Perioperative hypothermia has been reported to increase the occurrence of cardiovascular complications. By increasing the activity of sympathetic nervous system, perioperative hypothermia also has the potential to increase cardiac injury and dysfunction associated with subarachnoid hemorrhage. METHODS The Intraoperative Hypothermia for Aneurysm Surgery Trial randomized patients undergoing cerebral aneurysm surgery to intraoperative hypothermia (n = 499, 33.3 degrees +/- 0.8 degrees C) or normothermia (n = 501, 36.7 degrees +/- 0.5 degrees C). Cardiovascular events (hypotension, arrhythmias, vasopressor use, myocardial infarction, and others) were prospectively followed until 3-month follow-up and were compared in hypothermic and normothermic patients. A subset of 62 patients (hypothermia, n = 33; normothermia, n = 29) also had preoperative and postoperative (within 24 h) measurement of cardiac troponin-I and echocardiography to explore the association between perioperative hypothermia and subarachnoid hemorrhage-associated myocardial injury and left ventricular function. RESULTS There was no difference between hypothermic and normothermic patients in the occurrence of any single cardiovascular event or in composite cardiovascular events. There was no difference in mortality (6%) between groups, and there was only a single primary cardiovascular death (normothermia). There was no difference between hypothermic and normothermic patients in postoperative versus preoperative left ventricular regional wall motion or ejection fraction. Compared with preoperative values, hypothermic patients had no postoperative increase in cardiac troponin-I (median change 0.00 microg/l), whereas normothermic patients had a small postoperative increase (median change + 0.01 microg/l, P = 0.038). CONCLUSION In patients undergoing cerebral aneurysm surgery, perioperative hypothermia was not associated with an increased occurrence of cardiovascular events.
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447
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Levick SP, Meléndez GC, Plante E, McLarty JL, Brower GL, Janicki JS. Cardiac mast cells: the centrepiece in adverse myocardial remodelling. Cardiovasc Res 2010; 89:12-9. [PMID: 20736239 DOI: 10.1093/cvr/cvq272] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Increased numbers of mast cells have been reported in explanted human hearts with dilated cardiomyopathy and in animal models of experimentally induced hypertension, myocardial infarction, and chronic volume overload secondary to aortocaval fistula and mitral regurgitation. Accordingly, mast cells have been implicated to have a major role in the pathophysiology of these cardiovascular disorders. In vitro studies have verified that mast cell proteases are capable of activating collagenase, gelatinases and stromelysin. Recent results have shown that with chronic ventricular volume overload, there is an elevation in mast cell density, which is associated with a concomitant increase in matrix metalloproteinase (MMP) activity and extracellular matrix degradation. However, the role of the cardiac mast cell is not one dimensional, with evidence from hypertension and cardiac transplantation studies suggesting that they can also assume a pro-fibrotic phenotype in the heart. These adverse events do not occur in mast cell deficient rodents or when cardiac mast cells are pharmacologically prevented from degranulating. This review is focused on the regulation and dual roles of cardiac mast cells in: (i) activating MMPs and causing myocardial fibrillar collagen degradation and (ii) causing fibrosis in the stressed, injured or diseased heart. Moreover, there is strong evidence that premenopausal female cardioprotection may at least partly be due to gender differences in cardiac mast cells. This too will be addressed.
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Affiliation(s)
- Scott P Levick
- Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, SC 29208, USA
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448
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Abstract
Neurogenic cardiomyopathies are raising a growing interest due to their multidisciplinary implications. Despite the body of literature, questions about pathophysiology, risk predictors and prognosis of the various clinical pictures are still open. The frequent observation of a reversible left ventricular dysfunction complicating subarachnoid haemorrhage drops several hints of discussion about the clinical and pathophysiological similarities with the 'typical' transient left ventricular apical ballooning syndrome. In the light of the latest clinical and pathophysiological evidences, transient left ventricular apical ballooning syndrome could no longer be considered as an exclusively 'apical' wall motion abnormality and this diagnosis had not to be ruled out in patients experiencing acute brain injury and cerebrovascular events. Each kind of reversible left ventricular dysfunction mediated by the central nervous system and initiated by acute brain injury, both physical, like intracranial bleeding or head traumas, and psychical, like sudden emotional stress, could be encompassed in a single definition with wider inclusion criteria, such as 'acute ballooning cardiomyopathy' (ABC), that is likely to be more representative of the real needs in the clinical setting.
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449
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Yee AH, Burns JD, Wijdicks EFM. Cerebral salt wasting: pathophysiology, diagnosis, and treatment. Neurosurg Clin N Am 2010; 21:339-52. [PMID: 20380974 DOI: 10.1016/j.nec.2009.10.011] [Citation(s) in RCA: 92] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cerebral salt wasting (CSW) is a syndrome of hypovolemic hyponatremia caused by natriuresis and diuresis. The mechanisms underlying CSW have not been precisely delineated, although existing evidence strongly implicates abnormal elevations in circulating natriuretic peptides. The key in diagnosis of CSW lies in distinguishing it from the more common syndrome of inappropriate secretion of antidiuretic hormone. Volume status, but not serum and urine electrolytes and osmolality, is crucial for making this distinction. Volume and sodium repletion are the goals of treatment of patients with CSW, and this can be performed using some combination of isotonic saline, hypertonic saline, and mineralocorticoids.
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Affiliation(s)
- Alan H Yee
- Department of Neurology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55905, USA.
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450
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Schneider F, Kadel C, Pagitz M, Sen S. Takotsubo cardiomyopathy and elevated troponin levels following cerebral seizure. Int J Cardiol 2010; 145:586-7. [PMID: 20580097 DOI: 10.1016/j.ijcard.2010.05.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2010] [Accepted: 05/30/2010] [Indexed: 10/19/2022]
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