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Abdullatef M, Omran M, Bitar A, Alsaid B. Prevalence of classic and non-classic pain sites of coronary artery disease: a cross-sectional study. BMC Cardiovasc Disord 2024; 24:445. [PMID: 39179977 PMCID: PMC11344326 DOI: 10.1186/s12872-024-04127-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Accepted: 08/16/2024] [Indexed: 08/26/2024] Open
Abstract
STUDY OBJECTIVE This study aims to assess the prevalence of both classic and non-classic pain sites in patients with ischemic heart disease, emphasizing the importance of recognizing and not disregarding non-classic symptoms. METHODS This cross-sectional study included 100 patients diagnosed with coronary artery disease (CAD) who were admitted to two major hospitals in Syria. classic pain was identified as pain located in the precordial area, with or without radiation to the neck, jaw, left shoulder or arm. Patients' demographics and previous medical history were documented to investigate any potential associations with non-classic pain. RESULTS 62% of the patients experienced non-classic pain, while 12% had no precordial pain. For those without precordial pain, the most common pain site was the left chest (66.7%). Non-classic pain was significantly associated with smoking, with 72.2% of smokers experiencing non-classic pain compared to 35.7% non-smokers (p = 0.001). Additionally, patients with previous heart disease were more likely to have non-classic pain (71.7%), compared with patients with no history of heart disease (51.1%) (p = 0.03). Other factors such as age, sex, and diabetes were not statistically significant. CONCLUSION Non-classic pain is common, affecting 62% of individuals, primarily in the right shoulder, right arm, and back. This type of pain could be associated with smoking and prior heart disease. Misdiagnosing coronary artery disease can have serious consequences, as patients with non-classic symptoms may miss important pre-hospital procedures like ECG.
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Affiliation(s)
| | - Maya Omran
- Faculty of Medicine, Damascus University, Damascus, Syria.
| | - Anas Bitar
- Faculty of Medicine, Damascus University, Damascus, Syria
| | - Bayan Alsaid
- Laboratory of Anatomy, Faculty of Medicine, Damascus University, Damascus, Syria
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Affaitati G, Costantini R, Fiordaliso M, Giamberardino MA, Tana C. Pain from Internal Organs and Headache: The Challenge of Comorbidity. Diagnostics (Basel) 2024; 14:1750. [PMID: 39202238 PMCID: PMC11354044 DOI: 10.3390/diagnostics14161750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 07/24/2024] [Accepted: 08/08/2024] [Indexed: 09/03/2024] Open
Abstract
Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain-headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes.
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Affiliation(s)
- Giannapia Affaitati
- Department of Innovative Technologies in Medicine and Dentistry, Center for Advanced Studies and Technology (CAST), G. D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | | | - Michele Fiordaliso
- Department of Medicine and Ageing Sciences, G D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Maria Adele Giamberardino
- Headache Center, Geriatrics Clinic, Department of Medicine and Science of Aging, Center for Advanced Studies and Technology (CAST), G. D’Annunzio University of Chieti, 66100 Chieti, Italy;
| | - Claudio Tana
- Headache Center, Geriatrics Clinic, SS Annunziata Hospital, 66100 Chieti, Italy
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Wu J, Lin F, Chen B. Daphnoretin inhibited SCI-induced inflammation and activation of NF-κB pathway in spinal dorsal horn. Aging (Albany NY) 2024; 16:9680-9691. [PMID: 38843384 PMCID: PMC11210226 DOI: 10.18632/aging.205893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 04/16/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVE Spinal cord injury (SCI) is a devastating disease for which there is no safe and effective treatment at present. Daphnoretin is a natural discoumarin compound isolated from Wikstroemia indica with various pharmacological activities. Our study aimed to investigate the role of Daphnoretin in NF-κB pathway activation and inflammatory response after SCI. METHODS A mouse SCI model was constructed, and the Basso Mouse Scale Score and subscore were used to evaluate the effect of Daphnoretin on the movement capacity of mice. The effect of Daphnoretin on the activation of glial cells in the mouse model and BV2 cells was observed by immunofluorescence. PCR and ELISA were used to detect the expression of inflammatory factors, and Western blot was performed to detect the protein expression associated with NF-κB pathway. RESULTS Daphnoretin inhibited the loss of movement ability and the activation of glial cells in mice after SCI, and it also inhibited the activation of NF-κB pathway and the expression of inflammatory factors TNF-α and IL-1β in vivo and in vitro. CONCLUSIONS Daphnoretin can inhibit the activation of NF-κB pathway and the inflammatory response induced by SCI. Our study demonstrates the potential of Daphnoretin on clinical application for the treatment of SCI.
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Affiliation(s)
- Jiazhang Wu
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
- Department of Orthopaedics, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, Fuzhou 350007, China
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Fengfei Lin
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
- Department of Orthopaedics, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, Fuzhou 350007, China
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
| | - Bin Chen
- Department of Orthopaedics, Fuzhou Second General Hospital, School of Clinical Medicine, Fujian Medical University, Fuzhou 350007, China
- Department of Orthopaedics, Fuzhou Second Hospital of Xiamen University, School of Medicine, Xiamen University, Fuzhou 350007, China
- Fujian Provincial Clinical Medical Research Center for First Aid and Rehabilitation in Orthopaedic Trauma, Fuzhou Trauma Medical Center, Fuzhou 350007, China
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4
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Moore JP. Interoceptive signals from the heart and coronary circulation in health and disease. Auton Neurosci 2024; 253:103180. [PMID: 38677129 DOI: 10.1016/j.autneu.2024.103180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024]
Abstract
This review considers interoceptive signalling from the heart and coronary circulation. Vagal and cardiac sympathetic afferent sensory nerve endings are distributed throughout the atria, ventricles (mainly left), and coronary artery. A small proportion of cardiac receptors attached to thick myelinated vagal afferents are tonically active during the cardiac cycle. Dependent upon location, these mechanoreceptors detect fluctuations in atrial volume and coronary arterial perfusion. Atrial volume and coronary arterial signals contribute to beat-to-beat feedback control and physiological homeostasis. Most cardiac receptors are attached to thinly myelinated or nonmyelinated C fibres, many of which are unresponsive to the cardiac cycle. Of these, there are many chemically sensitive cardiac receptors which are activated during myocardial stress by locally released endogenous substances. In contrast, some tonically inactive receptors become activated by irregular ventricular wall mechanics or by distortion of the ischaemic myocardium. Furthermore, some are excited both by chemical mediators of ischaemia and wall abnormalities. Reflex responses arising from cardiac receptors attached to thinly myelinated or nonmyelinated are complex. Impulses that project centrally through vagal afferents elicit sympathoinhibition and hypotension, whereas impulses travelling in cardiac sympathetic afferents and spinal pathways elicit sympathoexcitation and hypertension. Two opposing cardiac reflexes may provide a mechanism for fine-tuning a composite haemodynamic response during myocardial stress. Sympathetic afferents provide the primary pathway for transmission of cardiac nociception to the central nervous system. However, activation of sympathetic afferents may increase susceptibility to life-threatening arrhythmias. Notably, the cardiac sympathetic afferent reflex predominates in pathophysiological states including hypertension and heart failure.
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Wu C, Sun M, Qile M, Zhang Y, Liu L, Cheng X, Dai X, Gross ER, Zhang Y, He S. Lysophosphatidic acid contributes to myocardial ischemia/reperfusion injury by activating TRPV1 in spinal cord. Basic Res Cardiol 2024; 119:329-348. [PMID: 38236300 PMCID: PMC11233190 DOI: 10.1007/s00395-023-01031-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 12/24/2023] [Accepted: 12/27/2023] [Indexed: 01/19/2024]
Abstract
Lysophosphatidic acid (LPA) is a bioactive phospholipid that plays a crucial role in cardiovascular diseases. Here, we question whether LPA contributes to myocardial ischemia/reperfusion (I/R) injury by acting on transient receptor potential vanilloid 1 (TRPV1) in spinal cord. By ligating the left coronary artery to establish an in vivo I/R mouse model, we observed a 1.57-fold increase in LPA level in the cerebrospinal fluid (CSF). The I/R-elevated CSF LPA levels were reduced by HA130, an LPA synthesis inhibitor, compared to vehicle treatment (4.74 ± 0.34 vs. 6.46 ± 0.94 μg/mL, p = 0.0014). Myocardial infarct size was reduced by HA130 treatment compared to the vehicle group (26 ± 8% vs. 46 ± 8%, p = 0.0001). To block the interaction of LPA with TRPV1 at the K710 site, we generated a K710N knock-in mouse model. The TRPV1K710N mice were resistant to LPA-induced myocardial injury, showing a smaller infarct size relative to TRPV1WT mice (28 ± 4% vs. 60 ± 7%, p < 0.0001). Additionally, a sequence-specific TRPV1 peptide targeting the K710 region produced similar protective effects against LPA-induced myocardial injury. Blocking the K710 region through K710N mutation or TRPV1 peptide resulted in reduced neuropeptides release and decreased activity of cardiac sensory neurons, leading to a decrease in cardiac norepinephrine concentration and the restoration of intramyocardial pro-survival signaling, namely protein kinase B/extracellular regulated kinase/glycogen synthase kinase-3β pathway. These findings suggest that the elevation of CSF LPA is strongly associated with myocardial I/R injury. Moreover, inhibiting the interaction of LPA with TRPV1 by blocking the K710 region uncovers a novel strategy for preventing myocardial ischemic injury.
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Affiliation(s)
- Chao Wu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Meiyan Sun
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Muge Qile
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Yu Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Liu Liu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xueying Cheng
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Xiaoxiao Dai
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China
| | - Eric R Gross
- Department of Anesthesiology, Perioperative and Pain Medicine, School of Medicine, Stanford University, Stanford, CA, USA
| | - Ye Zhang
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China.
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
| | - Shufang He
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, 678 Furong Road, Hefei, 230601, Anhui Province, China.
- Key Laboratory of Anesthesiology and Perioperative Medicine of Anhui Higher Education Institutes, Anhui Medical University, Hefei, China.
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Theofilis P, Antonopoulos AS, Sagris M, Papanikolaou A, Oikonomou E, Tsioufis K, Tousoulis D. Silent Myocardial Ischemia: From Pathophysiology to Diagnosis and Treatment. Biomedicines 2024; 12:259. [PMID: 38397860 PMCID: PMC10886642 DOI: 10.3390/biomedicines12020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 01/18/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Silent myocardial ischemia (SMI), characterized by a lack of overt symptoms despite an inadequate blood supply to the myocardium, remains a challenging entity in cardiovascular medicine. The pathogenesis involves intricate interactions of vascular, neurohormonal, and metabolic factors, contributing to perfusion deficits without the characteristic chest pain. Understanding these mechanisms is pivotal for recognizing diverse clinical presentations and designing targeted interventions. Diagnostic strategies for SMI have evolved from traditional electrocardiography to advanced imaging modalities, including stress echocardiography, single-photon emission computed tomography (SPECT), positron emission tomography (PET), and cardiac magnetic resonance imaging (MRI). Treating SMI is a matter of ongoing debate, as the available evidence on the role of invasive versus medical management is controversial. This comprehensive review synthesizes current knowledge of silent myocardial ischemia, addressing its pathophysiology, diagnostic modalities, and therapeutic interventions.
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Affiliation(s)
- Panagiotis Theofilis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
| | - Alexios S. Antonopoulos
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
| | - Marios Sagris
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
| | - Aggelos Papanikolaou
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Thoracic Diseases General Hospital “Sotiria”, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Konstantinos Tsioufis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
| | - Dimitris Tousoulis
- 1st Department of Cardiology, “Hippokration” General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (M.S.); (A.P.); (K.T.)
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Paz Y, Levy Y, Grosman-Rimon L, Shinfeld A. Nonpharmacological interventions for 'no-option' refractory angina patients. J Cardiovasc Med (Hagerstown) 2024; 25:13-22. [PMID: 37942734 DOI: 10.2459/jcm.0000000000001566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
Refractory angina pectoris (RAP) defined as chronic anginal chest pain because of coronary artery disease (CAD) is a major problem. The increase in the number of patients with RAP in recent years is because of the increasing aging population and improved survival rates among patients with CAD. Management of patients with RAP is often extremely challenging. In this review, we present several interventional approaches for RAP, including device therapies, lifestyle intervention, and cell therapies. Some of these treatments are currently used in the management of RAP, whereas other treatments are under investigation.
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Affiliation(s)
- Yoav Paz
- General Intensive Care Unit, Sourasky Medical Center, Tel Aviv, Israel, affiliated with Sackler Faculty of Medicine, Tel Aviv University
| | - Yair Levy
- Department of Medicine, Meir Hospital, Kfar-Saba, Israel
| | - Liza Grosman-Rimon
- School of Graduate Studies, Levinsky-Wingate Academic College, Wingate Institute, Netanya, Israel
| | - Amihay Shinfeld
- Department of Cardiac Surgery, Sheba Medical Center, Tel Hashomer, Tel Aviv, Israel
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Sohinki D, Mehta V, Ardell J, Stavrakis S, Po SS, Yousif A. Pseudo-vagal Responses Elicited by Cryoballoon Ablation. J Innov Card Rhythm Manag 2023; 14:5690-5696. [PMID: 38155725 PMCID: PMC10752428 DOI: 10.19102/icrm.2023.14123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 08/28/2023] [Indexed: 12/30/2023] Open
Abstract
Pulmonary vein isolation via cryoballoon (CB) ablation is the cornerstone ablation strategy for the treatment of atrial fibrillation (AF). Acute intraprocedural hypotensive and/or bradycardic responses have been reported in patients undergoing CB ablation for AF. However, it remains unclear as to whether these are due to a true vagal response (VR), which can be used to predict long-term outcomes of CB ablation. We analyzed 139 freezes across 17 patients who received CB ablation for paroxysmal AF, measuring vital signs and freeze characteristics. Only one freeze was associated with both hypotension and bradycardia, constituting a true VR. Several freezes were associated with hypotension only that did not respond to atropine administration, suggesting that these responses are not associated with a VR. Hypotensive responses were significantly associated with ice bubble bursts during CB deflation. Unlike the true VR reported in patients undergoing conscious sedation, the presence of acute hypotension shortly after CB deflation cannot be used as a predictor for long-term ablation outcomes.
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Affiliation(s)
- Daniel Sohinki
- Division of Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Vinay Mehta
- Division of Cardiology, Medical College of Georgia, Augusta, GA, USA
| | - Jeffrey Ardell
- Cardiac Arrhythmia Center, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Stavros Stavrakis
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Sunny S. Po
- Section of Cardiovascular Diseases and Heart Rhythm Institute, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ali Yousif
- Department of Cardiology, Baylor Scott and White Health, Prosper, TX, USA
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9
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Yamaguchi T, Salavatian S, Kuwabara Y, Hellman A, Taylor BK, Howard-Quijano K, Mahajan A. Thoracic Dorsal Root Ganglion Application of Resiniferatoxin Reduces Myocardial Ischemia-Induced Ventricular Arrhythmias. Biomedicines 2023; 11:2720. [PMID: 37893094 PMCID: PMC10604235 DOI: 10.3390/biomedicines11102720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND A myocardial ischemia/reperfusion (IR) injury activates the transient receptor potential vanilloid 1 (TRPV1) dorsal root ganglion (DRG) neurons. The activation of TRPV1 DRG neurons triggers the spinal dorsal horn and the sympathetic preganglionic neurons in the spinal intermediolateral column, which results in sympathoexcitation. In this study, we hypothesize that the selective epidural administration of resiniferatoxin (RTX) to DRGs may provide cardioprotection against ventricular arrhythmias by inhibiting afferent neurotransmission during IR injury. METHODS Yorkshire pigs (n = 21) were assigned to either the sham, IR, or IR + RTX group. A laminectomy and sternotomy were performed on the anesthetized animals to expose the left T2-T4 spinal dorsal root and the heart for IR intervention, respectively. RTX (50 μg) was administered to the DRGs in the IR + RTX group. The activation recovery interval (ARI) was measured as a surrogate for the action potential duration (APD). Arrhythmia risk was investigated by assessing the dispersion of repolarization (DOR), a marker of arrhythmogenicity, and measuring the arrhythmia score and the number of non-sustained ventricular tachycardias (VTs). TRPV1 and calcitonin gene-related peptide (CGRP) expressions in DRGs and CGRP expression in the spinal cord were assessed using immunohistochemistry. RESULTS The RTX mitigated IR-induced ARI shortening (-105 ms ± 13 ms in IR vs. -65 ms ± 11 ms in IR + RTX, p = 0.028) and DOR augmentation (7093 ms2 ± 701 ms2 in IR vs. 3788 ms2 ± 1161 ms2 in IR + RTX, p = 0.020). The arrhythmia score and VT episodes during an IR were decreased by RTX (arrhythmia score: 8.01 ± 1.44 in IR vs. 3.70 ± 0.81 in IR + RTX, p = 0.037. number of VT episodes: 12.00 ± 3.29 in IR vs. 0.57 ± 0.3 in IR + RTX, p = 0.002). The CGRP expression in the DRGs and spinal cord was decreased by RTX (DRGs: 6.8% ± 1.3% in IR vs. 0.6% ± 0.2% in IR + RTX, p < 0.001. Spinal cord: 12.0% ± 2.6% in IR vs. 4.5% ± 0.8% in IR + RTX, p = 0.047). CONCLUSIONS The administration of RTX locally to thoracic DRGs reduces ventricular arrhythmia in a porcine model of IR, likely by inhibiting spinal afferent hyperactivity in the cardio-spinal sympathetic pathways.
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Affiliation(s)
- Tomoki Yamaguchi
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
| | - Siamak Salavatian
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
- Division of Cardiology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Yuki Kuwabara
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
| | - Abigail Hellman
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
| | - Bradley K. Taylor
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
| | - Kimberly Howard-Quijano
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA; (T.Y.); (S.S.); (Y.K.); (A.H.); (B.K.T.); (K.H.-Q.)
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA
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10
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Law M, Sachdeva R, Darrow D, Krassioukov A. Cardiovascular Effects of Spinal Cord Stimulation: The Highs, the Lows, and the Don't Knows. Neuromodulation 2023:S1094-7159(23)00714-6. [PMID: 37665302 DOI: 10.1016/j.neurom.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/31/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND OBJECTIVES There are many potential etiologies of impaired cardiovascular control, from chronic stress to neurodegenerative conditions or central nervous system lesions. Since 1959, spinal cord stimulation (SCS) has been reported to modulate blood pressure (BP), heart rate (HR), and HR variability (HRV), yet the specific stimulation sites and parameters to induce a targeted cardiovascular (CV) change for mitigating abnormal hemodynamics remain unclear. To investigate the ability and parameters of SCS to modulate the CV, we reviewed clinical studies using SCS with reported HR, BP, or HRV findings. MATERIALS AND METHODS A keyword-based electronic search was conducted through MEDLINE, Embase, and PubMed data bases, last searched on February 3, 2023. Inclusion criteria were studies with human participants receiving SCS with comparison with SCS turned off, with reporting of either HR, HRV, or BP findings. Non-English studies, conference abstracts, and studies not reporting standalone effects of SCS when comparing SCS with non-SCS interventions were excluded. Results were plotted for visual analysis. When available, participant-specific stimulation parameters and effects were extracted and quantitatively analyzed using ordinary least squares regression. RESULTS A total of 59 studies were included in this review; 51 studies delivered SCS invasively through implanted/percutaneous leads. Eight studies used noninvasive, transcutaneous electrodes. We found numerous reports of cervical, high thoracic, and mid-to-low thoracolumbar SCS increasing resting BP, and cervical/mid-to-low thoracolumbar SCS decreasing BP. The effect of SCS location on HR and HRV was equivocal. We were unable to analyze stimulation parameters owing to inadequate parameter reporting in many publications. CONCLUSIONS Our findings suggest CV neuromodulation, particularly BP modulation, with SCS to be a promising frontier. Further research with larger randomized controlled trials and detailed reporting of SCS parameters will be necessary for appropriate evaluation of SCS as a CV therapy.
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Affiliation(s)
- Marco Law
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Rahul Sachdeva
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
| | - David Darrow
- Department of Neurosurgery, University of Minnesota, Minneapolis, MN, USA; Division of Neurosurgery, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Andrei Krassioukov
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada; Department of Medicine, University of British Columbia, Vancouver, BC, Canada; G.F. Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
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11
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Choi E, Lee YH, Park HK. Orofacial Pain with Cardiac Origin of Coronary Artery Disease: A Case Report and Literature Review. Case Rep Dent 2023; 2023:6304637. [PMID: 37475834 PMCID: PMC10356533 DOI: 10.1155/2023/6304637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 07/22/2023] Open
Abstract
When diagnosing orofacial pain, clinicians should also consider non-odontogenic origin and systemic diseases as possible etiological factors, along with odontogenic origin. This case report aimed to provide information for early detection of orofacial pain of cardiac origin by dentists, when pain due to coronary artery disease is the only presenting symptom. A 60-year-old male patient with unexplained isolated bilateral jaw pain that had persisted for the past 5 years was referred to a dentist by an anesthesiologist who suspected temporomandibular joint disorder. In oral examination, no specific pathological changes were observed in the oral cavity, including teeth, surrounding alveolar bone, and buccal mucosa. Magnetic resonance imaging and conventional radiography showed no pathological destruction or abnormalities of bone and soft tissue in the temporomandibular joint region. However, pain was precipitated by ordinary daily activities, and the pain alleviating factor was rest. Eventually, the patient was referred to a cardiologist for further evaluation since his pain was induced by physical activity. Coronary artery disease (CAD) was diagnosed using coronary computed tomography angiography, and the pain was considered to be angina pectoris. Percutaneous coronary intervention was successfully done for the patient, after which his orofacial symptoms disappeared. To conclude, isolated craniofacial pain of cardiac origin may lead to patients seeking dental care or visiting orofacial pain clinics. In these settings, dentists and orofacial pain specialists may contribute to the diagnosis of CAD and refer patients for cardiac evaluation and appropriate management.
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Affiliation(s)
- Eunhye Choi
- Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
- Department of Oral Medicine and Oral Diagnosis, Bucheon Apple Tree Dental Hospital, 20, Bucheon-ro, Bucheon-si, Gyeonggi-do, Republic of Korea
| | - Yeon-Hee Lee
- Department of Orofacial Pain and Oral Medicine, Kyung Hee University Dental Hospital, Kyung Hee University School of Dentistry, #613 Hoegi-dong, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Hee-Kyung Park
- Department of Oral Medicine and Oral Diagnosis, Dental Research Institute, Seoul National University School of Dentistry, Seoul 03080, Republic of Korea
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12
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Rao Y, Liu W, Zhu Y, Lin Q, Kuang C, Huang H, Jiao B, Ma L, Lin J. Altered functional brain network patterns in patients with migraine without aura after transcutaneous auricular vagus nerve stimulation. Sci Rep 2023; 13:9604. [PMID: 37311825 DOI: 10.1038/s41598-023-36437-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 06/03/2023] [Indexed: 06/15/2023] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) shows excellent effects on relieving clinical symptoms in migraine patients. Nevertheless, the neurological mechanisms of taVNS for migraineurs remain unclear. In recent years, voxel-wise degree centrality (DC) and functional connectivity (FC) methods were extensively utilized for exploring alterations in patterns of FC in the resting-state brain. In the present study, thirty-five migraine patients without aura and thirty-eight healthy controls (HCs) were recruited for magnetic resonance imaging scans. Firstly, this study used voxel-wise DC analysis to explore brain regions where abnormalities were present in migraine patients. Secondly, for elucidating neurological mechanisms underlying taVNS in migraine, seed-based resting-state functional connectivity analysis was employed to the taVNS treatment group. Finally, correlation analysis was performed to explore the relationship between alterations in neurological mechanisms and clinical symptoms. Our findings indicated that migraineurs have lower DC values in the inferior temporal gyrus (ITG) and paracentral lobule than in healthy controls (HCs). In addition, migraineurs have higher DC values in the cerebellar lobule VIII and the fusiform gyrus than HCs. Moreover, after taVNS treatment (post-taVNS), patients displayed increased FC between the ITG with the inferior parietal lobule (IPL), orbitofrontal gyrus, angular gyrus, and posterior cingulate gyrus than before taVNS treatment (pre-taVNS). Besides, the post-taVNS patients showed decreased FC between the cerebellar lobule VIII with the supplementary motor area and postcentral gyrus compared with the pre-taVNS patients. The changed FC of ITG-IPL was significantly related to changes in headache intensity. Our study suggested that migraine patients without aura have altered brain connectivity patterns in several hub regions involving multisensory integration, pain perception, and cognitive function. More importantly, taVNS modulated the default mode network and the vestibular cortical network related to the dysfunctions in migraineurs. This paper provides a new perspective on the potential neurological mechanisms and therapeutic targets of taVNS for treating migraine.
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Affiliation(s)
- Yuyang Rao
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Wenting Liu
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Yunpeng Zhu
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Qiwen Lin
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Changyi Kuang
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Huiyuan Huang
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Bingqing Jiao
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China
| | - Lijun Ma
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China.
| | - Jiabao Lin
- Department of Psychology, School of Public Health and Management, Guangzhou University of Chinese Medicine, No.232, Huandong Road, University Town, Guangzhou, 510006, China.
- Institut des Sciences Cognitives Marc Jeannerod, CNRS UMR 5229, Université Claude Bernard Lyon 1, Lyon, France.
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13
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Quinodoz A, Luthi F, Revaz S, Konzelmann M. Acute myopericarditis and left shoulder capsulitis following second dose of mRNA SARS-CoV-2 Moderna vaccination. BMJ Case Rep 2023; 16:16/6/e254110. [PMID: 37263680 DOI: 10.1136/bcr-2022-254110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Vaccination against mRNA SARS-CoV-2 has been administered on a very large scale and various side effects have been described. The increased risk of myopericarditis is known, and only a few cases of shoulder capsulitis have been reported after vaccination. These two pathologies have never been reported in the same patient after vaccination. Our article presents the history of a man in his 40s who presented with myopericarditis a few days after vaccination against SARS-CoV-2 with mRNA(Messenger RNA) Moderna® vaccine and who at the same time developed shoulder capsulitis. His cardiovascular symptoms resolved rapidly, and his shoulder symptoms improved/resolved within 1 year. This case should make physicians aware of the possibility of several concomitant side effects following vaccination against SARS-CoV-2.
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Affiliation(s)
- Adrien Quinodoz
- Department of Musculoskeletal Rehabilitation, Clinique Romande de réadaptation, Sion, Switzerland
| | - Francois Luthi
- Department of Musculoskeletal Rehabilitation, Clinique Romande de réadaptation, Sion, Switzerland
- Department of Physical medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Sylvie Revaz
- Assessment and consultation service, Clinique Romande de réadaptation, Sion, Switzerland
| | - Michel Konzelmann
- Assessment and consultation service, Clinique Romande de réadaptation, Sion, Switzerland
- Research service, Clinique Romande de réadaptation, Sion, Switzerland
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14
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Navarro-Pérez MP, Espinosa-Rueda J, Ballesta-Martínez S, Revilla-Martí P, Olesen J, Bellosta-Diago E, Santos-Lasaosa S. Prevalence, clinical characteristics and associated factors of cardiac cephalalgia: A prospective study. Cephalalgia 2023; 43:3331024231160743. [PMID: 36918763 DOI: 10.1177/03331024231160743] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The prevalence of cardiac cephalalgia is unknown and there is limited information about its clinical features. We aimed to assess the prevalence of cardiac cephalalgia, its clinical characteristics and associated factors. METHODS We conducted a prospective study of patients with suspected acute coronary syndrome admitted to the Cardiology Service at Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain, over a one-year period. We interviewed patients within the first 24 hours of admission using a standardized case-report form to assess the presence of headache in relation to the acute coronary syndrome and its characteristics. RESULTS We included 438 patients, 381 with confirmed myocardial ischemia. Prevalence of cardiac cephalalgia was 14.2% (n = 54). The most common features were frontal location, pressing quality and moderate intensity. Pain referred to the jaws (aOR 2.61; 95% CI 1.33-5.12; p = 0.005), palpitations (aOR 3.65; 95% CI 1.57-8.50; p = 0.003) and circumflex coronary artery as the culprit artery for the myocardial ischemia (aOR 3.8; 95% CI 1.07-13.74; p = 0.021) were related to cardiac whereas history of hypertension was inversely associated (aOR 0.37: 95% CI 0.18-0.74; p = 0.005). CONCLUSION The prevalence of cardiac cephalalgia was 14.2%. Our study provides valuable information about cardiac cephalalgia characteristics that suggest revision of current diagnostic criteria.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Judit Espinosa-Rueda
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sara Ballesta-Martínez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Pablo Revilla-Martí
- Aragon Institute for Health Research, Zaragoza, Spain.,Cardiology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Aragon Institute for Health Research, Zaragoza, Spain
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15
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Zucker IH, Xia Z, Wang HJ. Potential Neuromodulation of the Cardio-Renal Syndrome. J Clin Med 2023; 12:803. [PMID: 36769450 PMCID: PMC9917464 DOI: 10.3390/jcm12030803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 01/16/2023] [Accepted: 01/17/2023] [Indexed: 01/20/2023] Open
Abstract
The cardio-renal syndrome (CRS) type 2 is defined as a progressive loss of renal function following a primary insult to the myocardium that may be either acute or chronic but is accompanied by a decline in myocardial pump performance. The treatment of patients with CRS is difficult, and the disease often progresses to end-stage renal disease that is refractory to conventional therapy. While a good deal of information is known concerning renal injury in the CRS, less is understood about how reflex control of renal sympathetic nerve activity affects this syndrome. In this review, we provide insight into the role of the renal nerves, both from the afferent or sensory side and from the efferent side, in mediating renal dysfunction in CRS. We discuss how interventions such as renal denervation and abrogation of systemic reflexes may be used to alleviate renal dysfunction in the setting of chronic heart failure. We specifically focus on a novel cardiac sensory reflex that is sensitized in heart failure and activates the sympathetic nervous system, especially outflow to the kidney. This so-called Cardiac Sympathetic Afferent Reflex (CSAR) can be ablated using the potent neurotoxin resinferitoxin due to the high expression of Transient Receptor Potential Vanilloid 1 (TRPV1) receptors. Following ablation of the CSAR, several markers of renal dysfunction are reversed in the post-myocardial infarction heart failure state. This review puts forth the novel idea of neuromodulation at the cardiac level in the treatment of CRS Type 2.
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Affiliation(s)
- Irving H. Zucker
- Department of Cellular and Integrative Physiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Zhiqiu Xia
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Han-Jun Wang
- Department of Anesthesiology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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16
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Shiba H, Kenzaka T. Straight Back Syndrome Presented with Chest and Back Pain: A Case Report. Int Med Case Rep J 2022; 15:611-614. [PMCID: PMC9635548 DOI: 10.2147/imcrj.s385312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 10/21/2022] [Indexed: 11/07/2022] Open
Abstract
A 17-year-old female adolescent presented with her mother to our clinic with a two-month history of left-sided chest pain and a one-week history of middle back pain. We diagnosed straight back syndrome based on the chest and thoracic radiographic findings and symptoms of chest pain, palpitations, and dyspnea. We reassured the patient that the disease was benign and advised her to start and continue chiropractic therapy. All symptoms, including back pain, disappeared in three weeks. Straight back syndrome is under-diagnosed, and back pain is less recognized as a symptom of the disease.
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Affiliation(s)
- Hiroshi Shiba
- Department of Internal Medicine, Suwa Central Hospital, Chino, Japan,Correspondence: Hiroshi Shiba, Department of Internal Medicine, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano-ken, 391-8503, Japan, Tel +81-0266-72-1000, Fax +81-0266-72-4120, Email
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan,Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Japan
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17
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Navarro-Pérez MP, Bellosta-Diago E, Olesen J, Santos-Lasaosa S. Cardiac cephalalgia: a narrative review and ICHD-3 criteria evaluation. J Headache Pain 2022; 23:136. [PMID: 36266636 PMCID: PMC9583508 DOI: 10.1186/s10194-022-01508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 10/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac cephalalgia is an unusual condition that occurs during an episode of myocardial ischemia. Information about cardiac cephalalgia is scarce and its characteristics and physiopathology remain unclear. Our aim is to provide a narrative review of clinical characteristics and physiopathology of cardiac cephalalgia and to evaluate the current diagnostic criteria. METHODS: A search through PubMed was undertaken for studies on cardiac cephalalgia published until 20th September 2022. We summarized the literature and provide a comprehensive review of the headache characteristics and possible mechanisms. We also evaluated current International Classification of Headache Disorders third edition diagnostic criteria based on prior reported cases. RESULTS: In total, 88 cases were found. Headache characteristics were variable. Occipital location and throbbing pain were the most frequently reported. Headache was accompanied in most cases by cardiac symptoms. Criterion B was fulfilled by 98% of cases, criterion C1 by 72%, and criteria C2a and C2b by 37 and 93.2%, respectively. Regarding headache features described in diagnostic criterion C3, 'moderate to severe intensity', 'accompanied by nausea', 'not accompanied by photophobia or phonophobia' and 'aggravated by exertion', were reported in 75, 31, 55 and 55% of cases, respectively. CONCLUSION Cardiac cephalalgia characteristics are variable and the headache features described in the diagnostic criterion C3 might not be adequate. Given that cardiac cephalalgia can be the manifestation of a life-threatening condition it is important to increase the knowledge about this entity.
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Affiliation(s)
- María Pilar Navarro-Pérez
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain.
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain.
| | - Elena Bellosta-Diago
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | - Sonia Santos-Lasaosa
- Neurology Department, Hospital Clínico Universitario Lozano Blesa, San Juan Bosco 15, 50009, Saragossa, Spain
- Aragon Institute for Health Research (IIS Aragón), Saragossa, Spain
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18
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Li W, Liu J, Chen A, Dai D, Zhao T, Liu Q, Song J, Xiong L, Gao XF. Shared nociceptive dorsal root ganglion neurons participating in acupoint sensitization. Front Mol Neurosci 2022; 15:974007. [PMID: 36106140 PMCID: PMC9465389 DOI: 10.3389/fnmol.2022.974007] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 07/26/2022] [Indexed: 11/13/2022] Open
Abstract
When the body is under pathological stress (injury or disease), the status of associated acupoints changes, including decreased pain threshold. Such changes in acupoint from a “silent” to an “active” state are considered “acupoint sensitization,” which has become an important indicator of acupoint selection. However, the mechanism of acupoint sensitization remains unclear. In this study, by retrograde tracing, morphological, chemogenetic, and behavioral methods, we found there are some dorsal root ganglion (DRG) neurons innervating the ST36 acupoint and ipsilateral hind paw (IHP) plantar simultaneously. Inhibition of these shared neurons induced analgesia in the complete Freund’s adjuvant (CFA) pain model and obstruction of nociceptive sensation in normal mice, and elevated the mechanical pain threshold (MPT) of ST36 acupoint in the CFA model. Excitation of shared neurons induced pain and declined the MPT of ST36 acupoint. Furthermore, most of the shared DRG neurons express TRPV1, a marker of nociceptive neurons. These results indicate that the shared nociceptive DRG neurons participate in ST36 acupoint sensitization in CFA-induced chronic pain. This raised a neural mechanism of acupoint sensitization at the level of primary sensory transmission.
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Affiliation(s)
- Wanrong Li
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
| | - Jia Liu
- Faculty of Anesthesiology, Changhai Hospital, Naval Medical University, Shanghai, China
| | - Aiwen Chen
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
| | - Danqing Dai
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
| | - Tiantian Zhao
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
| | - Qiong Liu
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
| | - Jianren Song
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lize Xiong
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
- *Correspondence: Lize Xiong,
| | - Xiao-Fei Gao
- Translational Research Institute of Brain and Brain-Like Intelligence, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Clinical Research Center for Anesthesiology and Perioperative Medicine, Tongji University, Shanghai, China
- Department of Anesthesiology and Perioperative Medicine, Shanghai Fourth People’s Hospital, School of Medicine, Tongji University, Shanghai, China
- Shanghai Key Laboratory of Anesthesiology and Brain Functional Modulation, Shanghai, China
- Xiao-Fei Gao,
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19
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Cui X, Sun G, Cao H, Liu Q, Liu K, Wang S, Zhu B, Gao X. Referred Somatic Hyperalgesia Mediates Cardiac Regulation by the Activation of Sympathetic Nerves in a Rat Model of Myocardial Ischemia. Neurosci Bull 2022; 38:386-402. [PMID: 35471719 PMCID: PMC9068860 DOI: 10.1007/s12264-022-00841-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
Myocardial ischemia (MI) causes somatic referred pain and sympathetic hyperactivity, and the role of sensory inputs from referred areas in cardiac function and sympathetic hyperactivity remain unclear. Here, in a rat model, we showed that MI not only led to referred mechanical hypersensitivity on the forelimbs and upper back, but also elicited sympathetic sprouting in the skin of the referred area and C8-T6 dorsal root ganglia, and increased cardiac sympathetic tone, indicating sympathetic-sensory coupling. Moreover, intensifying referred hyperalgesic inputs with noxious mechanical, thermal, and electro-stimulation (ES) of the forearm augmented sympathetic hyperactivity and regulated cardiac function, whereas deafferentation of the left brachial plexus diminished sympathoexcitation. Intradermal injection of the α2 adrenoceptor (α2AR) antagonist yohimbine and agonist dexmedetomidine in the forearm attenuated the cardiac adjustment by ES. Overall, these findings suggest that sensory inputs from the referred pain area contribute to cardiac functional adjustment via peripheral α2AR-mediated sympathetic-sensory coupling.
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Affiliation(s)
- Xiang Cui
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Guang Sun
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.,Research Center of Traditional Chinese Medicine, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, Jilin, 130021, China
| | - Honglei Cao
- Department of Cardiology, Jining No. 1 People's Hospital, Jining, 272100, Shandong, China
| | - Qun Liu
- Department of Needling Manipulation, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Kun Liu
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Shuya Wang
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China
| | - Bing Zhu
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
| | - Xinyan Gao
- Department of Physiology, Institute of Acupuncture and Moxibustion, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
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20
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Karunakaran KD, Kussman BD, Peng K, Becerra L, Labadie R, Bernier R, Berry D, Green S, Zurakowski D, Alexander ME, Borsook D. Brain-based measures of nociception during general anesthesia with remifentanil: A randomized controlled trial. PLoS Med 2022; 19:e1003965. [PMID: 35452458 PMCID: PMC9075662 DOI: 10.1371/journal.pmed.1003965] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2022] [Accepted: 03/14/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Catheter radiofrequency (RF) ablation for cardiac arrhythmias is a painful procedure. Prior work using functional near-infrared spectroscopy (fNIRS) in patients under general anesthesia has indicated that ablation results in activity in pain-related cortical regions, presumably due to inadequate blockade of afferent nociceptors originating within the cardiac system. Having an objective brain-based measure for nociception and analgesia may in the future allow for enhanced analgesic control during surgical procedures. Hence, the primary aim of this study is to demonstrate that the administration of remifentanil, an opioid widely used during surgery, can attenuate the fNIRS cortical responses to cardiac ablation. METHODS AND FINDINGS We investigated the effects of continuous remifentanil on cortical hemodynamics during cardiac ablation under anesthesia. In a randomized, double-blinded, placebo (PL)-controlled trial, we examined 32 pediatric patients (mean age of 15.8 years,16 females) undergoing catheter ablation for cardiac arrhythmias at the Cardiology Department of Boston Children's Hospital from October 2016 to March 2020; 9 received 0.9% NaCl, 12 received low-dose (LD) remifentanil (0.25 mcg/kg/min), and 11 received high-dose (HD) remifentanil (0.5 mcg/kg/min). The hemodynamic changes of primary somatosensory and prefrontal cortices were recorded during surgery using a continuous wave fNIRS system. The primary outcome measures were the changes in oxyhemoglobin concentration (NadirHbO, i.e., lowest oxyhemoglobin concentration and PeakHbO, i.e., peak change and area under the curve) of medial frontopolar cortex (mFPC), lateral prefrontal cortex (lPFC) and primary somatosensory cortex (S1) to ablation in PL versus remifentanil groups. Secondary measures included the fNIRS response to an auditory control condition. The data analysis was performed on an intention-to-treat (ITT) basis. Remifentanil group (dosage subgroups combined) was compared with PL, and a post hoc analysis was performed to identify dose effects. There were no adverse events. The groups were comparable in age, sex, and number of ablations. Results comparing remifentanil versus PL show that PL group exhibit greater NadirHbO in inferior mFPC (mean difference (MD) = 1.229, 95% confidence interval [CI] = 0.334, 2.124, p < 0.001) and superior mFPC (MD = 1.206, 95% CI = 0.303, 2.109, p = 0.001) and greater PeakHbO in inferior mFPC (MD = -1.138, 95% CI = -2.062, -0.214, p = 0.002) and superior mFPC (MD = -0.999, 95% CI = -1.961, -0.036, p = 0.008) in response to ablation. S1 activation from ablation was greatest in PL, then LD, and HD groups, but failed to reach significance, whereas lPFC activation to ablation was similar in all groups. Ablation versus auditory stimuli resulted in higher PeakHbO in inferior mFPC (MD = 0.053, 95% CI = 0.004, 0.101, p = 0.004) and superior mFPC (MD = 0.052, 95% CI = 0.013, 0.091, p < 0.001) and higher NadirHbO in posterior superior S1 (Pos. SS1; MD = -0.342, 95% CI = -0.680, -0.004, p = 0.007) during ablation of all patients. Remifentanil group had smaller NadirHbO in inferior mFPC (MD = 0.098, 95% CI = 0.009, 0.130, p = 0.003) and superior mFPC (MD = 0.096, 95% CI = 0.008, 0.116, p = 0.003) and smaller PeakHbO in superior mFPC (MD = -0.092, 95% CI = -0.680, -0.004, p = 0.007) during both the stimuli. Study limitations were small sample size, motion from surgery, indirect measure of nociception, and shallow penetration depth of fNIRS only allowing access to superficial cortical layers. CONCLUSIONS We observed cortical activity related to nociception during cardiac ablation under general anesthesia with remifentanil. It highlights the potential of fNIRS to provide an objective pain measure in unconscious patients, where cortical-based measures may be more accurate than current evaluation methods. Future research may expand on this application to produce a real-time indication of pain that will aid clinicians in providing immediate and adequate pain treatment. TRIAL REGISTRATION ClinicalTrials.gov NCT02703090.
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Affiliation(s)
- Keerthana Deepti Karunakaran
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Barry D. Kussman
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Ke Peng
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Département en Neuroscience, Centre de Recherche du CHUM, l’Université de Montréal Montreal, Québec, Canada
| | - Lino Becerra
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Robert Labadie
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Rachel Bernier
- Division of Cardiac Anesthesia, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Delany Berry
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Stephen Green
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Zurakowski
- Division of Biostatistics, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Mark E. Alexander
- Department of Cardiology, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - David Borsook
- The Center for Pain and the Brain, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Psychiatry and Radiology, Massachusetts General Hospital, Boston, Massachusetts, United States of America
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21
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Wang X, Kanda H, Tsujino T, Kogure Y, Zhu F, Yamamoto S, Sakaguchi T, Noguchi K, Dai Y. Reactive Oxygen Species Cause Exercise-Induced Angina in a Myocardial Ischaemia-Reperfusion Injury Model. Int J Mol Sci 2022; 23:ijms23052820. [PMID: 35269964 PMCID: PMC8910887 DOI: 10.3390/ijms23052820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 11/26/2022] Open
Abstract
Percutaneous coronary intervention (PCI) effectively treats obstructive coronary artery syndrome. However, 30–40% patients continue to have angina after a successful PCI, thereby reducing patient satisfaction. The mechanisms underlying persistent angina after revascularisation therapy are still poorly understood; hence, the treatment or guideline for post-PCI angina remains unestablished. Thus, this study aimed to investigate the mechanisms underlying effort angina in animals following myocardial ischaemia-reperfusion (I/R) injury. Phosphorylated extracellular signal-regulated kinase (p-ERK), a marker for painful stimulation-induced neuronal activation, was used for the investigation. After a forced treadmill exercise (FTE), the number of p-ERK-expressing neurons increased in the superficial dorsal horn of the I/R model animals. Moreover, FTE evoked hydrogen peroxide (H2O2) production in the I/R-injured heart, inducing angina through TRPA1 activation on cardiac sensory fibres. Notably, the treatment of a TEMPOL, a reactive oxygen species scavenger, or TRPA1−/− mice successfully alleviated the FTE-induced p-ERK expression in the dorsal horn. The production of H2O2, a reactive oxygen species, through physical exercise contributes to angina development following I/R. Hence, our findings may be useful for understanding and treating angina following revascularisation therapy.
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Affiliation(s)
- Xiaohang Wang
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (X.W.); (T.S.)
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
| | - Hirosato Kanda
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
- Department of Anatomy and Neuroscience, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | - Takeshi Tsujino
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan
| | - Yoko Kogure
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
| | - Feng Zhu
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
| | - Satoshi Yamamoto
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
| | - Taichi Sakaguchi
- Department of Cardiovascular Surgery, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan; (X.W.); (T.S.)
| | - Koichi Noguchi
- Department of Anatomy and Neuroscience, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
| | - Yi Dai
- Department of Pharmacy, School of Pharmacy, Hyogo University of Health Sciences, Kobe 650-8530, Hyogo, Japan; (H.K.); (T.T.); (Y.K.); (F.Z.); (S.Y.)
- Department of Anatomy and Neuroscience, Hyogo College of Medicine, Nishinomiya 663-8501, Hyogo, Japan;
- Correspondence:
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22
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Mehra R, Tjurmina OA, Ajijola OA, Arora R, Bolser DC, Chapleau MW, Chen PS, Clancy CE, Delisle BP, Gold MR, Goldberger JJ, Goldstein DS, Habecker BA, Handoko ML, Harvey R, Hummel JP, Hund T, Meyer C, Redline S, Ripplinger CM, Simon MA, Somers VK, Stavrakis S, Taylor-Clark T, Undem BJ, Verrier RL, Zucker IH, Sopko G, Shivkumar K. Research Opportunities in Autonomic Neural Mechanisms of Cardiopulmonary Regulation: A Report From the National Heart, Lung, and Blood Institute and the National Institutes of Health Office of the Director Workshop. JACC Basic Transl Sci 2022; 7:265-293. [PMID: 35411324 PMCID: PMC8993767 DOI: 10.1016/j.jacbts.2021.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/09/2021] [Accepted: 11/10/2021] [Indexed: 12/22/2022]
Abstract
This virtual workshop was convened by the National Heart, Lung, and Blood Institute, in partnership with the Office of Strategic Coordination of the Office of the National Institutes of Health Director, and held September 2 to 3, 2020. The intent was to assemble a multidisciplinary group of experts in basic, translational, and clinical research in neuroscience and cardiopulmonary disorders to identify knowledge gaps, guide future research efforts, and foster multidisciplinary collaborations pertaining to autonomic neural mechanisms of cardiopulmonary regulation. The group critically evaluated the current state of knowledge of the roles that the autonomic nervous system plays in regulation of cardiopulmonary function in health and in pathophysiology of arrhythmias, heart failure, sleep and circadian dysfunction, and breathing disorders. Opportunities to leverage the Common Fund's SPARC (Stimulating Peripheral Activity to Relieve Conditions) program were characterized as related to nonpharmacologic neuromodulation and device-based therapies. Common themes discussed include knowledge gaps, research priorities, and approaches to develop novel predictive markers of autonomic dysfunction. Approaches to precisely target neural pathophysiological mechanisms to herald new therapies for arrhythmias, heart failure, sleep and circadian rhythm physiology, and breathing disorders were also detailed.
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Key Words
- ACE, angiotensin-converting enzyme
- AD, autonomic dysregulation
- AF, atrial fibrillation
- ANS, autonomic nervous system
- Ach, acetylcholine
- CNS, central nervous system
- COPD, chronic obstructive pulmonary disease
- CSA, central sleep apnea
- CVD, cardiovascular disease
- ECG, electrocardiogram
- EV, extracellular vesicle
- GP, ganglionated plexi
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- HFrEF, heart failure with reduced ejection fraction
- HRV, heart rate variability
- LQT, long QT
- MI, myocardial infarction
- NE, norepinephrine
- NHLBI, National Heart, Lung, and Blood Institute
- NPY, neuropeptide Y
- NREM, non-rapid eye movement
- OSA, obstructive sleep apnea
- PAH, pulmonary arterial hypertension
- PV, pulmonary vein
- REM, rapid eye movement
- RV, right ventricular
- SCD, sudden cardiac death
- SDB, sleep disordered breathing
- SNA, sympathetic nerve activity
- SNSA, sympathetic nervous system activity
- TLD, targeted lung denervation
- asthma
- atrial fibrillation
- autonomic nervous system
- cardiopulmonary
- chronic obstructive pulmonary disease
- circadian
- heart failure
- pulmonary arterial hypertension
- sleep apnea
- ventricular arrhythmia
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Affiliation(s)
- Reena Mehra
- Cleveland Clinic, Cleveland, Ohio, USA
- Case Western Reserve University, Cleveland, Ohio, USA
| | - Olga A. Tjurmina
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
| | | | - Rishi Arora
- Feinberg School of Medicine at Northwestern University, Chicago, Illinois, USA
| | | | - Mark W. Chapleau
- University of Iowa Carver College of Medicine, Iowa City, Iowa, USA
| | | | | | | | - Michael R. Gold
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - David S. Goldstein
- National Institute of Neurological Disorders and Stroke, Bethesda, Maryland, USA
| | - Beth A. Habecker
- Oregon Health and Science University School of Medicine, Portland, Oregon, USA
| | - M. Louis Handoko
- Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | | | - James P. Hummel
- Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | - Marc A. Simon
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- University of California-San Francisco, San Francisco, California, USA
| | | | - Stavros Stavrakis
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | | | | | - Richard L. Verrier
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - George Sopko
- National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
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23
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Komisaruk BR, Rodriguez del Cerro MC. How Does Our Brain Generate Sexual Pleasure? INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:602-611. [PMID: 38595785 PMCID: PMC10903593 DOI: 10.1080/19317611.2021.1989534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 09/24/2021] [Accepted: 09/27/2021] [Indexed: 04/11/2024]
Abstract
We present herein an exploratory essay on sexual pleasure, in support of the objective of developing an evidence base of knowledge for the WAS Declaration of Sexual Rights. We have attempted to account for the feeling of erotic sexual pleasure, in terms of what is known about neuronal function. The brain regions that are activated during women's orgasm, and their perceptual and physiological roles, are compared with brain regions related to chemically induced euphoria and craving. The brain regions that are activated at orgasm match those that are activated by both euphoria and craving. Based on these findings, we propose that erotic, sensual feeling is a simultaneous activation of euphoria plus craving. The importance of sensory stimulation, proprioception, sensations, and feelings is emphasized by evidence that their disruption leads to pathologies. The process of buildup of excitation to a peak and then resolution is proposed as a basic "orgasmic" property of the nervous system shared by multiple systems, as in a sneeze, which we consider to be a non-genital orgasm. We postulate a process by which an excitation pattern feels pleasurable and - at higher intensity - euphoric, if it is congruent with an unconscious dynamic "template," but aversive and at higher intensity painful, to the extent that it is incongruent with the template. Under this formulation, peak neuronal excitation that is congruent with the unconscious, simultaneously "getting what is craved," generates orgasmic, erotic, sexual pleasure.
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Affiliation(s)
- Barry R. Komisaruk
- Department of Psychology, Rutgers University – Newark, Newark, New Jersey, USA
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24
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Wang J, Wu XC, Zhang MM, Ren JH, Sun Y, Liu JZ, Wu XQ, He SY, Li YQ, Zhang JB. Spinal cord stimulation reduces cardiac pain through microglial deactivation in rats with chronic myocardial ischemia. Mol Med Rep 2021; 24:835. [PMID: 34608504 PMCID: PMC8503748 DOI: 10.3892/mmr.2021.12475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 09/07/2021] [Indexed: 01/14/2023] Open
Abstract
Angina pectoris is cardiac pain that is a common clinical symptom often resulting from myocardial ischemia. Spinal cord stimulation (SCS) is effective in treating refractory angina pectoris, but its underlying mechanisms have not been fully elucidated. The spinal dorsal horn is the first region of the central nervous system that receives nociceptive information; it is also the target of SCS. In the spinal cord, glial (astrocytes and microglia) activation is involved in the initiation and persistence of chronic pain. Thus, the present study investigated the possible cardiac pain-relieving effects of SCS on spinal dorsal horn glia in chronic myocardial ischemia (CMI). CMI was established by left anterior descending artery ligation surgery, which induced significant spontaneous/ongoing cardiac pain behaviors, as measured using the open field test in rats. SCS effectively improved such behaviors as shown by open field and conditioned place preference tests in CMI model rats. SCS suppressed CMI-induced spinal dorsal horn microglial activation, with downregulation of ionized calcium-binding adaptor protein-1 expression. Moreover, SCS inhibited CMI-induced spinal expression of phosphorylated-p38 MAPK, which was specifically colocalized with the spinal dorsal horn microglia rather than astrocytes and neurons. Furthermore, SCS could depress spinal neuroinflammation by suppressing CMI-induced IL-1β and TNF-α release. Intrathecal administration of minocycline, a microglial inhibitor, alleviated the cardiac pain behaviors in CMI model rats. In addition, the injection of fractalkine (microglia-activating factor) partially reversed the SCS-produced analgesic effects on CMI-induced cardiac pain. These results indicated that the therapeutic mechanism of SCS on CMI may occur partially through the inhibition of spinal microglial p38 MAPK pathway activation. The present study identified a novel mechanism underlying the SCS-produced analgesic effects on chronic cardiac pain.
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Affiliation(s)
- Jian Wang
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Xiao-Chen Wu
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Ming-Ming Zhang
- Department of Anatomy and K.K. Leung Brain Research Centre, Air Force Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jia-Hao Ren
- Department of Anatomy and K.K. Leung Brain Research Centre, Air Force Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Yi Sun
- Department of Anatomy and K.K. Leung Brain Research Centre, Air Force Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jing-Zhen Liu
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Xi-Qiang Wu
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Si-Yi He
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
| | - Yun-Qing Li
- Department of Anatomy and K.K. Leung Brain Research Centre, Air Force Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Jin-Bao Zhang
- Department of Cardiothoracic Surgery, General Hospital of Western Theater Command, Chengdu, Sichuan 610083, P.R. China
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25
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Abstract
PURPOSE OF THE REVIEW Ischemic heart disease is among the most common causes of morbidity and mortality worldwide. In its stable manifestation, obstructing coronary artery stenoses prevent myocardial blood flow from matching metabolic needs of the heart under exercise conditions, which manifests clinically as dyspnea or chest pain. Prolonged bouts of ischemia may result in permanent myocardial dysfunction, heart failure, and eventually reduced survival. The aim of the present work is to review currently available approaches to provide relief of ischemia in stable coronary artery disease (CAD). RECENT FINDINGS Several pharmacological and interventional approaches have proven effectiveness in reducing the burden of ischemia in stable CAD and allow for symptom control and quality of life improvement. However, substantial evidence in favor of improved survival with ischemia relief is lacking, and recently published randomized controlled trial suggests that only selected groups of patients may substantially benefit from this approach. Pharmacological treatments aimed at reducing ischemia were shown to significantly reduce ischemic symptoms but failed to provide prognostic benefit. Myocardial revascularization is able to re-establish adequate coronary artery flow and was shown to improve survival in selected groups of patients, i.e., those with significant left main CAD or severe left ventricular dysfunction in multivessel CAD. Outside the previously mentioned categories, revascularization appears to improve symptoms control over medical therapy, but does not confer prognostic advantage. More studies are needed to elucidate the role of systematic invasive functional testing to identify individuals more likely to benefit from revascularization and to evaluate the prognostic role of chronic total occlusion recanalization.
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26
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Davies A, Fox K, Galassi AR, Banai S, Ylä-Herttuala S, Lüscher TF. Management of refractory angina: an update. Eur Heart J 2021; 42:269-283. [PMID: 33367764 DOI: 10.1093/eurheartj/ehaa820] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/17/2020] [Accepted: 10/03/2020] [Indexed: 12/15/2022] Open
Abstract
Despite the use of anti-anginal drugs and/or percutaneous coronary interventions (PCI) or coronary artery bypass grafting, the proportion of patients with coronary artery disease who have daily or weekly angina ranges from 2% to 24%. Refractory angina refers to long-lasting symptoms (for >3 months) due to established reversible ischaemia, which cannot be controlled by escalating medical therapy with the use of 2nd- and 3rd-line pharmacological agents, bypass grafting, or stenting. While there is uncertain prognostic benefit, the treatment of refractory angina is important to improve the quality of life of the patients affected. This review focuses on conventional pharmacological approaches to treating refractory angina, including guideline directed drug combination and dosages. The symptomatic and prognostic impact of advanced and novel revascularization strategies such as chronic total occlusion PCI, transmyocardial laser revascularization, coronary sinus occlusion, radiation therapy for recurrent restenosis, and spinal cord stimulation are also covered and recommendations of the 2019 ESC Guidelines on the Diagnosis and Management of Chronic Coronary Syndromes discussed. Finally, the potential clinical use of current angiogenetic and stem cell therapies in reducing ischaemia and/or pain is evaluated.
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Affiliation(s)
- Allan Davies
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | - Kim Fox
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK
| | | | - Shmuel Banai
- Slezak Super Centre for Cardiac Research, Tel Aviv University, Tel Aviv, Israel.,Tel Aviv Medical Centre, Tel Aviv, Israel
| | | | - Thomas F Lüscher
- National Heart and Lung Institute, Imperial College, Guy Scadding Building, Dovehouse Street, London SW3 6LY, UK.,Royal Brompton & Harefield Hospitals, London, UK.,University of Zurich, Center for Molecular Cardiology, University of Zurich, Switzerland
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27
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Sun L, Zhang Q, Li N, Bao S, Wang D, Li X. Cardiac cephalalgia closely associated with acute myocardial infarction. Am J Emerg Med 2021; 47:350.e1-350.e3. [PMID: 33744054 DOI: 10.1016/j.ajem.2021.03.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 03/02/2021] [Accepted: 03/06/2021] [Indexed: 12/25/2022] Open
Abstract
Cardiac cephalalgia is an uncommon symptom occurring in coronary artery disease. It is difficult to identify cardiac cephalalgia and link it to coronary artery disease because these patients present with only a headache and no typical symptoms of angina, such as chest pain, radiating pain, or chest tightness. Currently, the diagnostic value of cardiac cephalalgia in acute myocardial infarction is still under debate. We here report a case of cardiac cephalalgia. An 83-year-old woman with a severe headache lasting 6 h was diagnosed with acute myocardial infarction. ST elevation and severe stenosis of the right coronary artery were observed. Passage of the guide wire and radiocontrast agent increased the intensity of the headache, which disappeared once the right coronary artery was opened. As of one month into follow-up, the headache had not recurred. These observations strongly indicate a close association between cardiac cephalalgia and acute myocardial infarction, and they could help diagnose acute myocardial infarction related to headaches.
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Affiliation(s)
- Li Sun
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Qingshan Zhang
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Nannan Li
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Shuai Bao
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China
| | - Deqi Wang
- Department of Cardiology, ZaoZhuang Municipal Hospital, Zaozhuang 277100, Shandong 250031, China
| | - Xiaolu Li
- Department of Emergency Medicine, The First Affiliated Hospital of Shandong First Medical University, Jinan, Shandong 250014, China.
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28
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Yalta K, Yetkin E, Yalta T. Systemic inflammation in patients with Takotsubo syndrome: a review of mechanistic and clinical implications. Monaldi Arch Chest Dis 2021; 91. [PMID: 33728882 DOI: 10.4081/monaldi.2021.1718] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 01/10/2021] [Indexed: 11/23/2022] Open
Abstract
Over recent decades, systemic inflammation as quantified with inflammation markers or indices has been extensively investigated in the setting of various cardiovascular conditions including heart failure (HF), acute coronary syndromes (ACS). In contrast, systemic inflammation in patients with takotsubo syndrome (TTS) has been an underrated phenomenon in clinical practice. On the other hand, experimental and clinical data have been rapidly accumulating in the recent years regarding pathogenetic, prognostic as well as therapeutic implications of systemic inflammation in TTS. Accordingly, the present article aims to provide a general perspective on mechanistic and clinical aspects of systemic inflammation in the setting of TTS.
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Affiliation(s)
- Kenan Yalta
- CardiologyDepartment, Trakya University, Edirne.
| | - Ertan Yetkin
- Cardiology Department, Derindere Hospital, Istanbul.
| | - Tulin Yalta
- Pathology Department, Trakya University, Edirne.
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Storari L, Barbari V, Brindisino F, Testa M, Filippo M. An unusual presentation of acute myocardial infarction in physiotherapy direct access: findings from a case report. Arch Physiother 2021; 11:5. [PMID: 33583432 PMCID: PMC7883431 DOI: 10.1186/s40945-021-00099-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 01/19/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Shoulder pain (SP) may originate from both musculoskeletal and visceral conditions. Physiotherapists (PT) may encounter patients with life-threatening pathologies that mimic musculoskeletal pain such as Acute Myocardial Infarction (AMI). A trained PT should be able to distinguish between signs and symptoms of musculoskeletal or visceral origin aimed at performing proper medical referral. CASE PRESENTATION A 46-y-old male with acute SP lasting from a week was diagnosed with right painful musculoskeletal shoulder syndrome, in two successive examinations by the emergency department physicians. However, after having experienced a shift of the pain on the left side, the patient presented to a PT. The PT recognized the signs and symptoms of visceral pain and referred him to the general practitioner, which identified a cardiac disease. The final diagnosis was acute myocardial infarction. CONCLUSION This case report highlights the importance of a thorough patient screening examination, especially for patients treated in an outpatient setting, which allow distinguishing between signs and symptoms of musculoskeletal from visceral diseases.
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Affiliation(s)
- Lorenzo Storari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Valerio Barbari
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise c/o Cardarelli Hospital, C/da Tappino, Campobasso, Italy
| | - Marco Testa
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy
| | - Maselli Filippo
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova - Campus of Savona, Savona, Italy.
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Jammal OMA, Diaz-Aguilar LD, Srinivas S, Plonsker J, Sahyouni R, Pham MH. Cervical Arthroplasty in the Treatment of Cervical Angina: Case Report and Review of the Literature. Neurospine 2020; 17:929-938. [PMID: 33401872 PMCID: PMC7788421 DOI: 10.14245/ns.2040074.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 04/26/2020] [Indexed: 11/30/2022] Open
Abstract
Cervical angina is an often-overlooked etiology of noncardiac chest pain that may mimic true angina pectoris but is due to cervical spine disease. Diagnosis can be difficult, and treatment ranges from conservative therapy to surgical management. However, of patient’s refractory to conservative therapy, approximately ninety percent experience postoperative relief of angina symptoms. Here, we present a case report on cervical angina and performed a systematic review of the literature. A 34-year-old male with prior surgery for thoracic outlet syndrome presented with persistent anterior neck and chest pain as well as posterior left scapular and upper lateral arm pain. The pain was refractory to 12 months of conservative therapy. Cardiac workup was negative and cervical spine imaging revealed a C6–7 herniation with neuroforaminal stenosis. A systematic literature search was conducted in PubMed, Web of Science, and Cochrane databases from database inception to April 2020. Studies reporting cervical level, average symptom duration, location of pain, and postoperative pain improvement were included. The patient's atypical symptoms were completely resolved after C6–7 anterior cervical discectomy and arthroplasty. To our knowledge, this is the first study which reports on the use of arthroplasty in the treatment of cervical angina. The systematic review included 11 articles from 1989–2020 consisting of 1,186 total patients and 109 patients (age range, 36–84 years; 60.7% male) meeting inclusion criteria. Symptom duration range was 2 days to 90 months, with the most common location of pain being localized to the anterior chest wall (66.7% of patients). All patients (100%) had postoperative resolution of their pain symptoms. The most common herniation level was C6–7 (87.3% of patients). We conclude that a broad and multidisciplinary approach is necessary for the diagnosis and management of noncardiac chest pain. When cervical disease is identified as the underlying cause for the angina-like pain, conservative therapy should be sought. Refractory cases should be treated surgically depending on the cervical pathology.
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Affiliation(s)
- Omar M Al Jammal
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Luis Daniel Diaz-Aguilar
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Shanmukha Srinivas
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Jillian Plonsker
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Ronald Sahyouni
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
| | - Martin H Pham
- Department of Neurosurgery, University of California San Diego School of Medicine, San Diego, CA, USA
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31
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Bellamoli M, Pellegrini P, de Manna ND, Genco B, Prati D, Carbonieri E, Faggian G, Ammirati E, Frigerio M, Ribichini FL. An odd couple: acalculous cholecystitis masking a fulminant myocarditis. J Cardiovasc Med (Hagerstown) 2020; 21:327-332. [PMID: 31789718 DOI: 10.2459/jcm.0000000000000909] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Michele Bellamoli
- Division of Cardiology, Department of Medicine, University of Verona
| | - Paolo Pellegrini
- Complex Operative Unit of Cardiology, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | | | - Bruno Genco
- Complex Operative Unit of Emergency Department, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | - Daniele Prati
- Division of Cardiology, Department of Medicine, University of Verona
| | - Emanuele Carbonieri
- Complex Operative Unit of Cardiology, Azienda ULSS 9, District 4, M. Magalini Hospital, Villafranca di Verona
| | | | | | - Maria Frigerio
- De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy
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32
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Akgul Caglar T, Durdu ZB, Turhan MU, Gunal MY, Aydın MS, Ozturk G, Cagavi E. Evaluation of the bilateral cardiac afferent distribution at the spinal and vagal ganglia by retrograde labeling. Brain Res 2020; 1751:147201. [PMID: 33171152 DOI: 10.1016/j.brainres.2020.147201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 10/08/2020] [Accepted: 11/03/2020] [Indexed: 12/20/2022]
Abstract
The identity of sensory neurons innervating the heart tissue and the extent of information reported to the brain via these neurons are poorly understood. In order to evaluate the multidimensional distribution and abundance of the cardiac spinal and vagal afferents, we assessed the retrograde labeling efficiency of various tracers, and mapped the cardiac afferents qualitatively and quantitatively at the bilateral nodose ganglia (NGs) and dorsal root ganglia (DRGs). From the five different retrograde tracers evaluated, Di-8-ANEPPQ yielded reproducibly the highest labeling efficiency of cardiac afferents. We demonstrated specific cardiac afferents at NGs and C4 to T11 DRG segments. Next, the 2D reconstruction of the tissue sections and 3D imaging of the whole NGs and DRGs revealed homogeneous and bilateral distribution of cardiac afferents. The quantitative analyses of the labeled cardiac afferents demonstrated approximately 5-6% of the soma in NGs that were equally distributed bilaterally. The neuronal character of Di-8-ANEPPQ labeled cells were validated by coimmunostaning with pan-neuronal marker Tuj-1. In addition, the cell diameters of labeled cardiac sensory neurons were found smaller than 20 μm, implying the nociceptor phenotype confirmed by co-labeling with TRPV1 and Di-8-ANEPPQ. Importantly, co-labeling with two distinct tracers Di-8-ANEPPQ and WGA-647 demonstrated exclusively the same cardiac afferents in DRGs and NGs, validating our findings. Collectively, our findings revealed the cardiac afferents in NGs bilaterally and DRGs with the highest labeling efficiency reported, spatial distribution and quantitation at both 2D and 3D levels, furthering our understanding of this novel neuron population.
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Affiliation(s)
- T Akgul Caglar
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey; Neuroscience Program, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - Z B Durdu
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey; Medical Biology and Genetics Program, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey
| | - M U Turhan
- School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - M Y Gunal
- Department of Physiology, School of Medicine, Alanya Alaaddin Keykubat University, Antalya, Turkey
| | - M S Aydın
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey
| | - G Ozturk
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey; Neuroscience Program, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey; Department of Physiology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - E Cagavi
- Regenerative and Restorative Medicine Research Center (REMER), Research Institute for Health Sciences and Technologies (SABITA), Istanbul Medipol University, Istanbul, Turkey; Medical Biology and Genetics Program, Institute of Health Sciences, Istanbul Medipol University, Istanbul, Turkey; Department of Medical Biology, School of Medicine, Istanbul Medipol University, Istanbul, Turkey.
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Abstract
The article discusses pharmacologic and interventional therapeutic options for patients with refractory angina. Refractory angina refers to long-lasting symptoms (≥3 months) due to established reversible ischemia in the presence of obstructive coronary artery disease, which cannot be controlled by escalating medical therapy with second-line and third-line pharmacologic agents, bypass grafting, or stenting. Due to an aging population, increased number of comorbidities, and advances in coronary artery disease treatment, incidence of refractory angina is growing. Although the number of therapeutic options is increasing, there is a lack of randomized clinical trials that could help create recommendations for this group of patients.
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Affiliation(s)
- Marcin Makowski
- Department of Interventional Cardiology, Medical University of Lodz, Central Clinical Hospital, ul. Pomorska 251, Lodz 92-213, Poland.
| | | | - Marzenna Zielińska
- Department of Interventional Cardiology, Medical University of Lodz, Central Clinical Hospital, ul. Pomorska 251, Lodz 92-213, Poland
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34
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Gallone G, Baldetti L, Tzanis G, Gramegna M, Latib A, Colombo A, Henry TD, Giannini F. Refractory Angina: From Pathophysiology to New Therapeutic Nonpharmacological Technologies. JACC Cardiovasc Interv 2020; 13:1-19. [PMID: 31918927 DOI: 10.1016/j.jcin.2019.08.055] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 08/12/2019] [Accepted: 08/20/2019] [Indexed: 12/16/2022]
Abstract
Despite optimal combination of guideline-directed anti-ischemic therapies and myocardial revascularization, a substantial proportion of patients with stable coronary artery disease continues to experience disabling symptoms and is often referred as "no-option." The appraisal of the pathways linking ischemia to symptom perception indicates a complex model of heart-brain interactions in the generation of the subjective anginal experience and inspired novel approaches that may be clinically effective in alleviating the angina burden of this population. Conversely, the prevailing ischemia-centered view of angina, with the focus on traditional myocardial revascularization as the sole option to address ischemia on top of medical therapy, hinders the experimental characterization and broad-scale clinical implementation of strongly needed therapeutic options. The interventionist, often the first physician to establish the diagnosis of refractory angina pectoris (RAP) following coronary angiography, should be aware of the numerous emerging technologies with the potential to improve quality of life in the growing population of RAP patients. This review describes the current landscape and the future perspectives on nonpharmacological treatment technologies for patients with RAP, with a view on the underlying physiopathological rationale and current clinical evidence.
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Affiliation(s)
- Guglielmo Gallone
- Division of Cardiology, Department of Medical Sciences, Città della Scienza e della Salute Hospital, University of Turin, Turin, Italy
| | - Luca Baldetti
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Georgios Tzanis
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Mario Gramegna
- Unit of Cardiovascular Interventions, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, Bronx, New York. https://twitter.com/azeemlatib
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy
| | - Timothy D Henry
- The Christ Hospital Heart and Vascular Center / The Carl and Edyth Lindner Center for Research and Education at The Christ Hospital, Cincinnati, Ohio; University of Florida, Gainesville, Florida
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research Maria Cecilia Hospital, Cotignola, Italy.
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35
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Affiliation(s)
- Jeffrey L. Ardell
- Address for correspondence: Dr. Jeffrey Ardell, University of California-Los Angeles Cardiac Arrhythmia Center, David Geffen School of Medicine, 100 Medical Plaza, Suite 660, Los Angeles, California 90095.
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36
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Wittbrodt MT, Moazzami K, Shah AJ, Lima BB, Hammadah M, Mehta PK, Quyyumi AA, Vaccarino V, Nye JA, Bremner JD. Neural responses during acute mental stress are associated with angina pectoris. J Psychosom Res 2020; 134:110110. [PMID: 32345456 PMCID: PMC8082434 DOI: 10.1016/j.jpsychores.2020.110110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 04/06/2020] [Accepted: 04/07/2020] [Indexed: 12/31/2022]
Abstract
UNLABELLED Angina pectoris is associated with increased risk of adverse cardiovascular events in coronary artery disease (CAD) patients, an effect not entirely attributable to the severity of CAD. OBJECTIVE Examine brain correlates of mental stress in patients with CAD with and without a history of angina. METHODS Participants (n = 170) with stable CAD completed the Seattle Angina Questionnaire along with other psychometric assessments. In this cross-sectional study, participants underwent laboratory-based mental stress testing using mental arithmetic and public speaking tasks along with control conditions in conjunction with positron emission tomography brain imaging using radiolabeled water. Brain activity during mental stress was compared between participants who did or did not report chest pain/angina in the previous month. A factor analysis was coupled with dominance analysis to identify brain regions associated with angina. RESULTS Participants reporting angina in the past month experienced greater (p < .005) activations within the left: frontal lobe (z = 4.01), temporal gyrus (z = 3.32), parahippocampal gyrus (z = 3.16), precentral gyrus (z = 3.14), right fusiform gyrus (z = 3.07), and bilateral cerebellum (z = 3.50) and deactivations within the right frontal gyrus (z = 3.67), left precuneus (z = 3.19), and left superior temporal gyrus (z = 3.11) during mental stress. A factor containing the left motor areas, inferior frontal lobe, and operculum (average McFadden's number addition = 0.057) in addition to depression severity (0.10) and adulthood trauma exposure (0.064) correlated with angina history. CONCLUSIONS Self-reported angina in patients with stable CAD is associated with increased neural responses to stress in a network including the inferior frontal lobe, motor areas, and operculum, potentially indicating an upregulated pain perception response.
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Affiliation(s)
- Matthew T. Wittbrodt
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Corresponding author at: 1821 Clifton Rd, Room 214, Atlanta, GA 30307, United States of America. (M.T. Wittbrodt)
| | - Kasra Moazzami
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Amit J. Shah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
| | - Bruno B. Lima
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Muhammad Hammadah
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Puja K. Mehta
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Arshed A. Quyyumi
- Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Viola Vaccarino
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States of America,Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, GA, United States of America
| | - Jonathon A. Nye
- Department of Radiology, Emory University School of Medicine, United States of America
| | - J. Douglas Bremner
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States of America,Department of Radiology, Emory University School of Medicine, United States of America,Atlanta VA Medical Center, Decatur, GA, United States of America
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37
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Nichols JB, McCallum AP, Khattar NK, Wei GZ, Gopinathannair R, Nauta HJW, Neimat JS. Pseudoanginal chest pain associated with vagal nerve stimulation: a case report. BMC Neurol 2020; 20:144. [PMID: 32312245 PMCID: PMC7171733 DOI: 10.1186/s12883-020-01693-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2020] [Accepted: 03/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Vagal nerve stimulation (VNS) can be an effective therapy for patients with epilepsy refractory to anti-epileptic drugs or intracranial surgery. While generally well tolerated, it has been associated with laryngospasm, hoarseness, coughing, dyspnea, throat and atypical chest pain, cardiac symptoms such as bradycardia and occasionally asystole. We report on a patient receiving vagal nerve stimulation who experienced severe typical anginal chest pain during VNS firing without any evidence of cardiac ischemia or dysfunction. Thus, the pain appeared to be neuropathic from the stimulation itself rather than nociceptive secondary to an effect on heart function. Case presentation A 29-year-old man, with a history of intractable frontal lobe epilepsy refractory to seven anti-epileptic medications and subsequent intracranial surgery, underwent VNS implantation without complications. On beginning stimulation, he began to have intermittent chest pain that corresponded temporally to his intermittent VNS firing. The description of his pain was pathognomonic of ischemic cardiac chest pain. On initial evaluation, he displayed Levine’s sign and reported crushing substernal chest pain radiating to the left arm, as well as shortness of breath walking upstairs that improved with rest. He underwent an extensive cardiac workup, including 12-lead ECG, cardiac stress test, echocardiogram, 12-day ambulatory cardiac monitoring, and continuous ECG monitoring each with and without stimulation of his device. The workup was consistently negative. Inability to resolve the pain necessitated the disabling and eventual removal of the device. Conclusion To our knowledge, this is the first report of pseudoanginal chest pain associated with VNS. This occurrence prompted our review of the mechanisms of cardiac chest pain and suggests that vagal afferents may convey anginal pain separately or in parallel with known spinal cord pain mechanisms. These insights into the physiology of chest pain may be of general interest and important to surgeons implanting VNS devices who may potentially encounter such symptoms.
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Affiliation(s)
- James B Nichols
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Abigail P McCallum
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Nicolas K Khattar
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - George Z Wei
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | | | - Haring J W Nauta
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Joseph S Neimat
- Department of Neurological Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
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Chan SA, Vaseghi M, Kluge N, Shivkumar K, Ardell JL, Smith C. Fast in vivo detection of myocardial norepinephrine levels in the beating porcine heart. Am J Physiol Heart Circ Physiol 2020; 318:H1091-H1099. [PMID: 32216617 PMCID: PMC7346543 DOI: 10.1152/ajpheart.00574.2019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The sympathetic nervous system modulates cardiac function by controlling key parameters such as chronotropy and inotropy. Sympathetic control of ventricular function occurs through extrinsic innervation arising from the stellate ganglia and thoracic sympathetic chain. In the healthy heart, sympathetic release of norepinephrine (NE) results in positive modulation of chronotropy, inotropy, and dromotropy, significantly increasing cardiac output. However, in the setting of myocardial infarction or injury, sympathetic activation persists, contributing to heart failure and increasing the risk of arrhythmias, including sudden cardiac death. Methodologies for detection of norepinephrine in cardiac tissue are limited. Present techniques rely on microdialysis for analysis by high-performance liquid chromatography coupled to electrochemical detection (HPLC-ED), radioimmunoassay, or other immunoassays, such as enzyme-linked immunosorbent assay (ELISA). Although significant information about the release and action of norepinephrine has been obtained with these methodologies, they are limited in temporal resolution, require large sample volumes, and provide results with a significant delay after sample collection (hours to weeks). In this study, we report a novel approach for measurement of interstitial cardiac norepinephrine, using minimally invasive, electrode-based, fast-scanning cyclic voltammetry (FSCV) applied in a beating porcine heart. The first multispatial and high temporal resolution, multichannel measurements of NE release in vivo are provided. Our data demonstrate rapid changes in interstitial NE profiles with regional differences in response to coronary ischemia, sympathetic nerve stimulation, and alterations in preload/afterload. NEW & NOTEWORTHY Pharmacological, electrical, or surgical regulation of sympathetic neuronal control can be used to modulate cardiac function and treat arrhythmias. However, present methods for monitoring sympathetic release of norepinephrine in the heart are limited in spatial and temporal resolution. Here, we provide for the first time a methodology and demonstration of practice and rapid measures of individualized regional autonomic neurotransmitter levels in a beating heart. We show dynamic, spatially resolved release profiles under normal and pathological conditions.
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Affiliation(s)
- Shyue-An Chan
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center, UCLA Health System, University of California Los Angeles, Los Angeles, California.,UCLA Neurocardiology Research Program of Excellence, University of California Los Angeles, Los Angeles, California
| | - Nicholas Kluge
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, UCLA Health System, University of California Los Angeles, Los Angeles, California.,UCLA Neurocardiology Research Program of Excellence, University of California Los Angeles, Los Angeles, California
| | - Jeffrey L Ardell
- UCLA Cardiac Arrhythmia Center, UCLA Health System, University of California Los Angeles, Los Angeles, California.,UCLA Neurocardiology Research Program of Excellence, University of California Los Angeles, Los Angeles, California
| | - Corey Smith
- Department of Physiology and Biophysics, Case Western Reserve University, Cleveland, Ohio
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39
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Dale EA, Kipke J, Kubo Y, Sunshine MD, Castro PA, Ardell JL, Mahajan A. Spinal cord neural network interactions: implications for sympathetic control of the porcine heart. Am J Physiol Heart Circ Physiol 2020; 318:H830-H839. [PMID: 32108524 DOI: 10.1152/ajpheart.00635.2019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Inherent and acquired factors determine the integrated autonomic response to cardiovascular stressors. Excessive sympathoexcitation to ischemic stress is a major contributor to the potential for sudden cardiac death. To define fundamental aspects of cardiac-related autonomic neural network interactions within the thoracic cord, specifically as related to modulating sympathetic preganglionic (SPN) neural activity. Adult, anesthetized Yorkshire pigs (n = 10) were implanted with penetrating high-density microarrays (64 electrodes) at the T2 level of the thoracic spinal cord to record extracellular potentials concurrently from left-sided dorsal horn (DH) and SPN neurons. Electrical stimulation of the T2 paravertebral chain allowed for antidromic identification of SPNs located in the intermediolateral cell column (57 of total 1,760 recorded neurons). Cardiac stressors included epicardial touch, occlusion of great vessels to transiently alter preload/afterload, and transient occlusion of the left anterior descending coronary artery (LAD). Spatial/temporal assessment of network interactions was characterized by cross-correlation analysis. While some DH neurons responded solely to changes in preload/afterload (8.5 ± 1.9%) or ischemic stress (10.5 ± 3.9%), the majority of cardiovascular-related DH neurons were multimodal (30.2 ± 4.7%) with ischemia sensitivity being one of the modalities (26.1 ± 4.7%). The sympathoexcitation associated with transient LAD occlusion was associated with increased correlations from baseline within DH neurons (2.43 ± 0.61 to 7.30 ± 1.84%, P = 0.04) and between SPN to DH neurons (1.32 ± 0.78 to 7.24 ± 1.84%, P = 0.02). DH to SPN network correlations were reduced during great vessel occlusion. In conclusion, increased intrasegmental network coherence within the thoracic spinal cord contributes to myocardial ischemia-induced sympathoexcitation.NEW & NOTEWORTHY In an in vivo pig model, we demonstrate using novel high-resolution neural electrode arrays that increased intrasegmental network coherence within the thoracic spinal cord contributes to myocardial ischemia-induced sympathoexcitation.
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Affiliation(s)
- Erica A Dale
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jasmine Kipke
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Yukiko Kubo
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Michael D Sunshine
- Department of Physical Therapy, University of Florida, Gainesville, Florida
| | - Peter A Castro
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Jeffrey L Ardell
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California.,Department of Medicine, Cardiac Arrhythmia Center and Cardiac Neurocardiology Research Program of Excellence, David Geffen School of Medicine, University of California, Los Angeles, California
| | - Aman Mahajan
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine, University of California, Los Angeles, California
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40
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Sparv D, Hofmann R, Gunnarsson A, James S, Hedberg C, Lauermann J, Torild P, Omerovic E, Bergström K, Haugen E, Bergström C, Linder R, Borg P, Haaga U, Olsson A, Böving E, Östlund O, Rylance R, Witt N, Erlinge D. The Analgesic Effect of Oxygen in Suspected Acute Myocardial Infarction: A Substudy of the DETO2X-AMI Trial. JACC Cardiovasc Interv 2019; 11:1590-1597. [PMID: 30139465 DOI: 10.1016/j.jcin.2018.04.043] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/08/2018] [Accepted: 04/10/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES In this substudy of the DETO2X-AMI (An Efficacy and Outcome Study of Supplemental Oxygen Treatment in Patients With Suspected Myocardial Infarction) trial, the authors aimed to assess the analgesic effect of moderate-flow oxygen supplementation in patients with suspected acute myocardial infarction (AMI) treated with percutaneous coronary intervention (PCI) and to study the effect of oxygen supplementation on the use of opiates and sedatives during PCI. BACKGROUND Routine oxygen in normoxemic patients with AMI does not provide clinical benefit. However, oxygen may relieve ischemic pain. METHODS Patients were randomly allocated to oxygen or ambient air according to the main study protocol. After PCI, peak level of pain during PCI was measured by the Visual Analogue Scale. The total amount of opiates and sedatives was reported. RESULTS A total of 622 patients were enrolled: 330 in the oxygen group and 292 in the ambient air group. There was no significant difference in peak level of pain (oxygen 4.0 [1.0 to 6.0] vs. air 3.0 [0.6 to 6.0]; p = 0.37), use of opiates (mg) (oxygen 0.0 [0.0 to 3.0] vs. air 0.0 [0.0 to 3.0]; p = 0.31), or use of sedatives between the groups (median [interquartile range]) (oxygen 2.5 [0.0 to 2.5] vs. air 2.5 [0.0 to 2.5]; p = 0.74). CONCLUSIONS In the present study, the authors did not find any analgesic effect of routine oxygen as compared with ambient air, and no differences in the use of sedatives and opiates during PCI. Our results indicate that moderate-flow oxygen supplementation does not relieve pain in normoxemic patients with suspected AMI undergoing treatment with PCI and should thus not be used for this purpose.
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Affiliation(s)
- David Sparv
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden.
| | - Robin Hofmann
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Annika Gunnarsson
- Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Stefan James
- Department of Medical Sciences and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Camilla Hedberg
- Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping, Sweden
| | - Jörg Lauermann
- Department of Internal Medicine, Division of Cardiology, Ryhov Hospital, Jönköping, Sweden
| | - Petronella Torild
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Elmir Omerovic
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Espen Haugen
- Department of Cardiology, Sundsvall Regional Hospital, Sundsvall, Sweden
| | - Camilla Bergström
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Rikard Linder
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Pia Borg
- Svensk PCI Värmland AB, Karlstad, Sweden
| | - Urban Haaga
- Department of Cardiology, Central Hospital Karlstad, Karlstad, Sweden
| | - Anneli Olsson
- Department of Cardiology, Skane University Hospital, Lund, Sweden
| | - Elin Böving
- Department of Cardiology, Södersjukhuset, Stockholm, Sweden
| | - Ollie Östlund
- Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Rebecca Rylance
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
| | - Nils Witt
- Department of Clinical Science and Education, Division of Cardiology, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Lund, Sweden
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Salavatian S, Ardell SM, Hammer M, Gibbons D, Armour JA, Ardell JL. Thoracic spinal cord neuromodulation obtunds dorsal root ganglion afferent neuronal transduction of the ischemic ventricle. Am J Physiol Heart Circ Physiol 2019; 317:H1134-H1141. [PMID: 31538809 DOI: 10.1152/ajpheart.00257.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Aberrant afferent signaling drives adverse remodeling of the cardiac nervous system in ischemic heart disease. The study objective was to determine whether thoracic spinal dorsal column stimulation (SCS) modulates cardiac afferent sensory transduction of the ischemic ventricle. In anesthetized canines (n = 16), extracellular activity generated by 62 dorsal root ganglia (DRG) soma (T1-T3), with verified myocardial ischemic (MI) sensitivity, were evaluated with and without 20-min preemptive SCS (T1-T3 spinal level; 50 Hz, 90% motor threshold). Transient MI was induced by 1-min coronary artery occlusion (CAO) of the left anterior descending (LAD) or circumflex (LCX) artery, randomized as to sequence. LAD and LCX CAO activated cardiac-related DRG neurons (LAD: 0.15 ± 0.04-1.05 ± 0.20 Hz, P < 0.00002; LCX: 0.08 ± 0.02-1.90 ± 0.45 Hz, P < 0.0003). SCS decreased basal neuronal activity of neurons that responded to LAD (0.15 ± 0.04 to 0.02 ± 0.01 Hz, P < 0.006) and LCX (0.08 ± 0.02 to 0.02 ± 0.01 Hz, P < 0.003). SCS suppressed responsiveness to transient MI (LAD: 1.05 ± 0.20-0.03 ± 0.01 Hz; P < 0.0001; LCX: 1.90 ± 0.45-0.03 ± 0.01 Hz; P < 0.001). Suprathreshold SCS (1 Hz) did not activate DRG neurons antidromically (n = 10 animals). Ventricular fibrillation (VF) was associated with a rapid increase in DRG activity to a maximum of 4.39 ± 1.07 Hz at 20 s after VF induction and a return to 90% of baseline within 10 s thereafter. SCS obtunds the capacity of DRG ventricular neurites to transduce the ischemic myocardium to second-order spinal neurons, a mechanism that would blunt reflex sympathoexcitation to myocardial ischemic stress, thereby contributing to its capacity to cardioprotect.NEW & NOTEWORTHY Aberrant afferent signaling drives adverse remodeling of the cardiac nervous system in ischemic heart disease. This study determined that thoracic spinal column stimulation (SCS) obtunds the capacity of dorsal root ganglia ventricular afferent neurons to transduce the ischemic myocardium to second-order spinal neurons, a mechanism that would blunt reflex sympathoexcitation to myocardial ischemic stress. This modulation does not reflect antidromic actions of SCS but likely reflects efferent-mediated changes at the myocyte-sensory neurite interface.
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Affiliation(s)
- Siamak Salavatian
- Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.,Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Sarah M Ardell
- Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.,Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Mathew Hammer
- Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.,Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - David Gibbons
- Department of Biomedical Sciences, East Tennessee State University, Johnson City, Tennessee
| | - J Andrew Armour
- Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.,Cardiac Arrhythmia Center, University of California, Los Angeles, California
| | - Jeffrey L Ardell
- Neurocardiology Research Program of Excellence, University of California, Los Angeles, California.,Cardiac Arrhythmia Center, University of California, Los Angeles, California
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Rahman MN, Artani A, Baloch F, Hussain B. Severity of Chest Pain among Acute Myocardial Infarction Patients with Diagonal Branch Vessel Disease: A Pilot Study. Cureus 2019; 11:e5519. [PMID: 31687294 PMCID: PMC6819063 DOI: 10.7759/cureus.5519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients. METHODS It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at Aga Khan University Hospital, Karachi (AKUH). Information on pain scores was measured using the Numeric Pain Rating Scale (NRS) before administration of analgesics. Other relevant variables were also recorded on a pre-structured questionnaire. RESULTS The mean age of all the participants in the study was 60 ± 11.0 years, with 16% of the patients being women. Among all AMI patients, the intensity of chest pain in patients with isolated diagonal branch vessel disease was 2.6 units higher as compared to those with other epicardial coronary vessel diseases (p-value: <0.001; 95% CI: 1.67 - 3.46). CONCLUSION This preliminary study indicates severe chest pain can be a differentiating symptom in AMI patients with diagonal branch disease. It emphasizes clinicians to look for a possibility of a diagonal branch as a culprit vessel in AMI for better judgment, as it is often overlooked. future studies may be conducted at multiple centers for larger sample size and better generalizability.
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Wang Q, Li ZX, Li YJ, He ZG, Chen YL, Feng MH, Li SY, Wu DZ, Xiang HB. Identification of lncRNA and mRNA expression profiles in rat spinal cords at various time‑points following cardiac ischemia/reperfusion. Int J Mol Med 2019; 43:2361-2375. [PMID: 30942426 PMCID: PMC6488167 DOI: 10.3892/ijmm.2019.4151] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 03/20/2019] [Indexed: 12/21/2022] Open
Abstract
The identification of the expression patterns of long non-coding RNAs (lncRNAs) and mRNAs in the spinal cord under normal and cardiac ischemia/reperfusion (I/R) conditions is essential for understanding the genetic mechanisms underlying the pathogenesis of cardiac I/R injury. The present study used high-throughput RNA sequencing to investigate differential gene and lncRNA expression patterns in the spinal cords of rats during I/R-induced cardiac injury. Male Sprague Dawley rats were assigned to the following groups: i) Control; ii) 2 h (2 h post-reperfusion); and iii) 0.5 h (0.5 h post-reperfusion). Further mRNA/lncRNA microarray analysis revealed that the expression profiles of lncRNA and mRNA in the spinal cords differed markedly between the control and 2 h groups, and in total 7,980 differentially expressed (>2-fold) lncRNAs (234 upregulated, 7,746 downregulated) and 3,428 mRNAs (767 upregulated, 2,661 downregulated) were identified. Reverse transcription-quantitative polymerase chain reaction analysis was performed to determine the expression patterns of several lncRNAs. The results indicated that the expression levels of lncRNA NONRATT025386 were significantly upregulated in the 2 and 0.5 h groups when compared with those in the control group, whereas the expression levels of NONRATT016113, NONRATT018298 and NONRATT018300 were elevated in the 2 h group compared with those in the control group; however, there was no statistically significant difference between the 0.5 h and control groups. Furthermore, the expression of lncRNA NONRATT002188 was significantly downregulated in the 0.5 and 2 h groups when compared with the control group. The present study determined the expression pattern of lncRNAs and mRNAs in rat spinal cords during cardiac I/R. It was suggested that lncRNAs and mRNAs from spinal cords may be novel therapeutic targets for the treatment of I/R-induced cardiac injury.
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Affiliation(s)
- Qian Wang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhi-Xiao Li
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Yu-Juan Li
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhi-Gang He
- Department of Emergency Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Ying-Le Chen
- Department of Anesthesiology, The First Affiliated Quanzhou Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Mao-Hui Feng
- Department of Oncology, Wuhan Peritoneal Cancer Clinical Medical Research Center, Zhongnan Hospital of Wuhan University, Hubei Key Laboratory of Tumor Biological Behaviors and Hubei Cancer Clinical Study Center, Wuhan, Hubei 430071, P.R. China
| | - Shun-Yuan Li
- Department of Anesthesiology, The First Affiliated Quanzhou Hospital of Fujian Medical University, Quanzhou, Fujian 362000, P.R. China
| | - Duo-Zhi Wu
- Department of Anesthesiology, People's Hospital of Hainan Province, Haikou, Hainan 570311, P.R. China
| | - Hong-Bing Xiang
- Department of Anesthesiology and Pain Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Kikuta S, Dalip D, Loukas M, Iwanaga J, Tubbs RS. Jaw pain and myocardial ischemia: A review of potential neuroanatomical pathways. Clin Anat 2019; 32:476-479. [PMID: 30847968 DOI: 10.1002/ca.23367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/12/2019] [Accepted: 03/05/2019] [Indexed: 02/06/2023]
Abstract
Cardiac pain is usually manifested as a crushing, squeezing, or sensation of pressure in the center of the chest. The pain can be referred to the left shoulder, neck, jaw, and epigastric region as well as the temporomandibular region, paranasal sinuses, and head in general. Although not well understood, during myocardial ischemia, the process of cardiac referred pain to craniofacial structures can be explained by the convergence of visceral and somatic relays at the trigeminal nucleus in the brain stem. The goal of this article is to review the possible pathways for referred jaw pain due to myocardial ischemia. Clin. Anat. 32:476-479, 2019. © 2019 Wiley Periodicals, Inc.
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Affiliation(s)
- Shogo Kikuta
- Seattle Science Foundation, Seattle, Washington.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Dominic Dalip
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Marios Loukas
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
| | - Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington.,Dental and Oral Medical Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington.,Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Effect of myocardial ischemic preconditioning on ischemia-reperfusion stimulation-induced activation in rat thoracic spinal cord with functional MRI. Int J Cardiol 2019; 285:59-64. [PMID: 30905517 DOI: 10.1016/j.ijcard.2019.03.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2018] [Revised: 03/06/2019] [Accepted: 03/13/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Myocardial ischemia and reperfusion-evoked spinal reflexes involve nociceptive signals that trigger neuronal excitation through cardiac afferents, projecting into the thoracic spinal cord. Ischemic preconditioning (IPC) involves brief episodes of sublethal ischemia and reperfusion enhances the resistance of the myocardium to subsequent ischemic insults. This study investigated the effects of IPC on ischemia-reperfusion (I/R) stimulation-induced activation in the thoracic spinal cord of rats. METHODS A new remotely controlled I/R model was established. The infarct size was determined as a percentage of area at risk (IS/AAR) and arrhythmia scores were evaluated. Non-invasive in vivo fMRI was used for signal quantitative analysis of thoracic spinal spatiotemporal. The role of IPC on the excitability of substantia gelatinosa (SG) neurons was assessed by spinal patch clamp recording technique. The altered expressions of c-Fos, SP, and CGRP in T4 segment were detected by immunohistochemical staining. RESULTS The novel I/R model was induced successfully and reliably utilized, and IPC treatment markedly reduced the myocardial infarct size. fMRI analysis revealed that IPC reduced the increased BOLD signals induced by prolonged ischemia-reperfusion. Patch clamp recording showed that IPC treatment reversed the enhanced excitability of SG neurons during I/R treatment. The results of immunofluorescent staining indicated that IPC mitigated the I/R-induced dramatic increase of c-Fos, and reduced the release of SP and CGRP in dorsal horns of spinal cord. CONCLUSIONS These results suggested that IPC suppressed neuronal activation induced by I/R stimuli in rat thoracic spinal cord using spinal cord fMRI and patch clamp recording techniques.
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Haddad R, Hentzen C, Le Breton F, Sheikh Ismael S, Amarenco G. Lumbosacral radicular pain during micturition, defecation or orgasm. Eur J Pain 2019; 23:1091-1097. [PMID: 30697909 DOI: 10.1002/ejp.1372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/01/2019] [Accepted: 01/20/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND The objective of this study was to describe, in a cohort of patients followed for bladder, bowel or sexual dysfunctions, the occurrence of radicular pain during micturition, defecation and/or orgasm. METHODS The study included all patients referred in our neuro-urology department and who suffered from radicular pain before, during or after micturition, defecation and/or orgasm. Data included demographic and medical variables, urodynamic and perineal electromyographic diagnosis. RESULTS A total of 30 patients (men: 70%, mean age 45.4 ± 11.8,) complained of radicular pain before, during or after orgasm (51.4%), micturition (34.3%), or defecation (14.3%). In 30% of cases, radiculopathy was found and was predicted by micturition pain. Other pathologies were as follows: vertebral (16.5%), pelvis and sacral (16.5%), inflammatory central nervous system (10%) lesions and peripheral neuropathies (6.7%). Neurological level of injury was between the lumbar and the sacral level. All spinal cord lesions were lesions of the conus medullaris. Patients also complained of lower urinary tract symptoms (70%), sexual (63.3%) and bowel (60%) disorders. In most cases, the urodynamic diagnosis was neurogenic bladder with peripheral abnormalities and the electromyographic diagnosis was distal neuropathy. CONCLUSION Radicular pain occurring during micturition, defecation or orgasm is a rare condition. The most common underlying lesion seems to be radiculopathy, from lumbar to sacral spine. The presence of these symptoms, in the absence of any known neurological condition, should suggest the practitioner a radiculopathy in most of the cases. In consequence, appropriate additional tests should be offered to these patients. SIGNIFICANCE Few data are available on sciatica during micturition, defecation or orgasm. This study underlines the need for appropriate tests if a patient complaint from this type of symptom. Indeed, the most common underlying lesion is a radiculopathy but can also be a lesion of conus medullaris.
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Affiliation(s)
- Rebecca Haddad
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Claire Hentzen
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Frederique Le Breton
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Samer Sheikh Ismael
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
| | - Gerard Amarenco
- Groupe de Recherche Clinique en Neuro-Urologie (GREEN), Service de Neuro-Urologie, Hôpitaux Universitaires Est Parisien, Sorbonne Universités, UPMC Univ Paris 06, AP-HP, GRC 01, Hôpital Tenon, Paris, France
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Lazari J, Money-Kyrle A, Wakerley BR. Cardiac cephalalgia: severe, non-exertional headache presenting as unstable angina. Pract Neurol 2018; 19:173-175. [DOI: 10.1136/practneurol-2018-002045] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2018] [Indexed: 11/04/2022]
Abstract
Cardiac cephalalgia is a migraine-like headache that occurs during episodes of myocardial ischaemia. Clinical characteristics of the headache vary widely but are often severe in intensity, worsen with reduced myocardial perfusion and resolve with reperfusion. It can present along with typical symptoms of angina pectoris, although not always. We present a 64-year-old man with a 6-month history of severe, non-exertional headaches occurring with increasing frequency. A resting ECG showed ST elevation in the inferior leads. His serum troponin I was not elevated. Coronary angiography showed severe stenosis of his right coronary artery, which was successfully stented by percutaneous coronary intervention. He remains headache free at 2-year follow-up.
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48
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Schiffman JS. Chest pain as a manifestation of hypokalemia in a pediatric patient. Am J Emerg Med 2017; 36:342.e3-342.e5. [PMID: 29126579 DOI: 10.1016/j.ajem.2017.11.001] [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: 09/11/2017] [Revised: 10/19/2017] [Accepted: 11/01/2017] [Indexed: 12/25/2022] Open
Abstract
Patients presenting to the emergency department with chest pain are common and a cause of significant concern to patients and families and physicians alike. The causes of chest pain are myriad. These causes span diverse categories including cardiovascular, respiratory, abdominal and gastrointestinal, musculoskeletal, psychiatric, hematologic and oncologic, and neurologic Thull-Freedman (2010) [1]. These diverse etiologies present a diagnostic and management challenge to the ER physician who is tasked to minimize unnecessary diagnostics while not missing any significant disease. Multiple reviews have discussed the various etiologies of chest pain in the pediatric patient presenting to the ER but none of these recent reviews has included hypokalemia as a cause of chest pain Talner and Carboni (2000), Cava and Sayger (2004), Ringstrom and Freedman (2006), Foy and Filippone (2015), Yeh and Yeh (2015) [2-6]. Additionally, no reviews of hypokalemia describe this condition presenting with chest pain (Mandal, 1997; Gennari, 2002; Medford-Davis and Rafique, 2014 [7-9]). This case report describes a pediatric patient who presents with chest pain that was attributed to hypokalemia. This report attempts to make practitioners aware that hypokalemia may present with chest pain and to encourage ER providers to include this in the differential diagnosis.
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Affiliation(s)
- Jonathan S Schiffman
- Valley Hospital, Department of Emergency Medicine, 223 North Van Dien Avenue, Ridgewood, NJ 07450, USA.
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49
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Nair J, Streeter KA, Turner SMF, Sunshine MD, Bolser DC, Fox EJ, Davenport PW, Fuller DD. Anatomy and physiology of phrenic afferent neurons. J Neurophysiol 2017; 118:2975-2990. [PMID: 28835527 DOI: 10.1152/jn.00484.2017] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 08/17/2017] [Accepted: 08/17/2017] [Indexed: 12/23/2022] Open
Abstract
Large-diameter myelinated phrenic afferents discharge in phase with diaphragm contraction, and smaller diameter fibers discharge across the respiratory cycle. In this article, we review the phrenic afferent literature and highlight areas in need of further study. We conclude that 1) activation of both myelinated and nonmyelinated phrenic sensory afferents can influence respiratory motor output on a breath-by-breath basis; 2) the relative impact of phrenic afferents substantially increases with diaphragm work and fatigue; 3) activation of phrenic afferents has a powerful impact on sympathetic motor outflow, and 4) phrenic afferents contribute to diaphragm somatosensation and the conscious perception of breathing. Much remains to be learned regarding the spinal and supraspinal distribution and synaptic contacts of myelinated and nonmyelinated phrenic afferents. Similarly, very little is known regarding the potential role of phrenic afferent neurons in triggering or modulating expression of respiratory neuroplasticity.
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Affiliation(s)
- Jayakrishnan Nair
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - Kristi A Streeter
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - Sara M F Turner
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - Michael D Sunshine
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - Donald C Bolser
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - Emily J Fox
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida.,McKnight Brain Institute, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and.,Brooks Rehabilitation, Jacksonville, Florida
| | - Paul W Davenport
- Department of Physiological Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
| | - David D Fuller
- Department of Physical Therapy, College of Public Health and Health Professions, University of Florida, Gainesville, Florida; .,McKnight Brain Institute, University of Florida, Gainesville, Florida.,Center for Respiratory Research and Rehabilitation, University of Florida, Gainesville, Florida; and
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50
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Abstract
In the last few years, exciting properties have emerged regarding the activation, signaling, mechanisms of action, and therapeutic targeting of the two types of neurotrophin receptors: the p75NTR with its intracellular and extracellular peptides, the Trks, their precursors and their complexes. This review summarizes these new developments, with particular focus on neurodegenerative diseases. Based on the evolving knowledge, innovative concepts have been formulated regarding the pathogenesis of these diseases, especially the Alzheimer's and two other, the Parkinson's and Huntington's diseases. The medical progresses include original procedures of diagnosis, started from studies in mice and now investigated for human application, based on innovative classes of receptor agonists and blockers. In parallel, comprehensive studies have been and are being carried out for the development of drugs. The relevance of these studies is based on the limitations of the therapies employed until recently, especially for the treatment of Alzheimer's patients. Starting from well known drugs, previously employed for non-neurodegenerative diseases, the ongoing progress has lead to the development of small molecules that cross rapidly the blood-brain barrier. Among these molecules the most promising are specific blockers of the p75NTR receptor. Additional drugs, that activate Trk receptors, were shown effective against synaptic loss and memory deficits. In the near future such approaches, coordinated with treatments with monoclonal antibodies and with developments in the microRNA field, are expected to improve the therapy of neurodegenerative diseases, and may be relevant also for other human disease conditions.
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Affiliation(s)
- Jacopo Meldolesi
- Department of Neuroscience, Vita-Salute San Raffaele University and Scientific Institute San Raffaele, via Olgettina 58, 20132 Milan, Italy.
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