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Pei Q, Yang J, Li B, Lin P, Zou L, Zhang J, Yin H, Sun J, Wang X, Vera A N, Dong Z, Yin D. Histological and functional assessment of a Takotsubo cardiomyopathy model established by immobilization stress. Pacing Clin Electrophysiol 2024; 47:373-382. [PMID: 38341623 DOI: 10.1111/pace.14930] [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: 02/13/2023] [Revised: 10/20/2023] [Accepted: 01/04/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Takotsubo cardiomyopathy (TTC), also known as stress-induced cardiomyopathy, resembles acute heart failure syndrome but lacks disease-specific diagnosis and treatment strategies. TTC accounts for approximately 5-6% of all suspected cases of acute coronary syndrome in women. At present, animal models of TTC are often created by large amounts of exogenous catecholamines such as isoproterenol. However, isoproterenol injection cannot fully simulate the onset of stress-induced cardiomyopathy in humans since stress is not an instantaneous event. METHODS Rats were immobilized for 6 h per day for 1-14 days. To examine whether the TTC model was successful, echocardiography was employed; Elisa detected serum sympathetic activation markers; and the Open-Field test (OFT) was used to analyze behavioral changes in rats after stress. Western blot and histology were used to assess sympathetic remodeling, inflammation levels, and fibrosis; qRT-PCR was used to explore the levels of fibrosis and myocardial hypertrophy. The electrical stability of ventricular was determined by electrophysiological testing. RESULTS The rats showed severe stress behavior and local sympathetic remodeling of the heart after only 1 day of stress. After 3 days of stress, the induction of ventricular tachyarrhythmia increased prominently. The highest incidence of TTC in rats was at 5 days of immobilization stress. The pathological left ventricular remodeling caused by immobilization (IMO) stress includes inflammatory infiltration, fibrosis, and myocardial hypertrophy. CONCLUSIONS Our study confirms the hypothesis that IMO stress can mimic Takotsubo cardiomyopathy, and the various effects on the heart depending on the duration of IMO stress. We observed the highest incidence of TTC occurred after 5 days of stress. Furthermore, there is a gradual occurrence of electrical and structural remodeling as the stress duration prolongs.
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Affiliation(s)
- Quanwei Pei
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jiemei Yang
- Department of Echocardiography, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin Li
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pengqi Lin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lina Zou
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Junpei Zhang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongpeng Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jingmei Sun
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xin Wang
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Nevzorova Vera A
- Institute Therapy and Instrumental Diagnostic, Pacific State Medical University, Vladivostok, Russia
| | - Zengxiang Dong
- The Key Laboratory of Cardiovascular Disease Acousto-Optic Electromagnetic Diagnosis and Treatment in Heilongjiang Province, the First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Dechun Yin
- Department of Cardiology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
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Belosludtseva NV, Pavlik LL, Mikheeva IB, Talanov EY, Serov DA, Khurtin DA, Belosludtsev KN, Mironova GD. Protective Effect of Uridine on Structural and Functional Rearrangements in Heart Mitochondria after a High-Dose Isoprenaline Exposure Modelling Stress-Induced Cardiomyopathy in Rats. Int J Mol Sci 2023; 24:17300. [PMID: 38139129 PMCID: PMC10744270 DOI: 10.3390/ijms242417300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
The pyrimidine nucleoside uridine and its phosphorylated derivates have been shown to be involved in the systemic regulation of energy and redox balance and promote the regeneration of many tissues, including the myocardium, although the underlying mechanisms are not fully understood. Moreover, rearrangements in mitochondrial structure and function within cardiomyocytes are the predominant signs of myocardial injury. Accordingly, this study aimed to investigate whether uridine could alleviate acute myocardial injury induced by isoprenaline (ISO) exposure, a rat model of stress-induced cardiomyopathy, and to elucidate the mechanisms of its action related to mitochondrial dysfunction. For this purpose, a biochemical analysis of the relevant serum biomarkers and ECG monitoring were performed in combination with transmission electron microscopy and a comprehensive study of cardiac mitochondrial functions. The administration of ISO (150 mg/kg, twice with an interval of 24 h, s.c.) to rats caused myocardial degenerative changes, a sharp increase in the serum cardiospecific markers troponin I and the AST/ALT ratio, and a decline in the ATP level in the left ventricular myocardium. In parallel, alterations in the organization of sarcomeres with focal disorganization of myofibrils, and ultrastructural and morphological defects in mitochondria, including disturbances in the orientation and packing density of crista membranes, were detected. These malfunctions were improved by pretreatment with uridine (30 mg/kg, twice with an interval of 24 h, i.p.). Uridine also led to the normalization of the QT interval. Moreover, uridine effectively inhibited ISO-induced ROS overproduction and lipid peroxidation in rat heart mitochondria. The administration of uridine partially recovered the protein level of the respiratory chain complex V, along with the rates of ATP synthesis and mitochondrial potassium transport, suggesting the activation of the potassium cycle through the mitoKATP channel. Taken together, these results indicate that uridine ameliorates acute ISO-induced myocardial injury and mitochondrial malfunction, which may be due to the activation of mitochondrial potassium recycling and a mild uncoupling leading to decreased ROS generation and oxidative damage.
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Affiliation(s)
- Natalia V. Belosludtseva
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
| | - Lubov L. Pavlik
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
| | - Irina B. Mikheeva
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
| | - Eugeny Yu. Talanov
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
| | - Dmitriy A. Serov
- Prokhorov General Physics Institute, Russian Academy of Sciences, Vavilov St. 38, 119991 Moscow, Russia;
| | - Dmitriy A. Khurtin
- Department of Biochemistry, Cell Biology and Microbiology, Mari State University, pl. Lenina 1, 424001 Yoshkar-Ola, Russia;
| | - Konstantin N. Belosludtsev
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
- Department of Biochemistry, Cell Biology and Microbiology, Mari State University, pl. Lenina 1, 424001 Yoshkar-Ola, Russia;
| | - Galina D. Mironova
- Institute of Theoretical and Experimental Biophysics, Russian Academy of Sciences, Institutskaya 3, 142290 Pushchino, Russia; (L.L.P.); (I.B.M.); (E.Y.T.); (K.N.B.)
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Marinković ST, Đukanović Đ, Duran M, Bajic Z, Sobot T, Uletilović S, Mandić-Kovacević N, Cvjetković T, Maksimović ŽM, Maličević U, Vesić N, Jovičić S, Katana M, Šavikin K, Djuric DM, Stojiljković MP, Škrbić R. Pomegranate Peel Extract Attenuates Isoprenaline-Induced Takotsubo-like Myocardial Injury in Rats. Pharmaceutics 2023; 15:1697. [PMID: 37376144 DOI: 10.3390/pharmaceutics15061697] [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: 05/07/2023] [Revised: 05/29/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023] Open
Abstract
Takotsubo syndrome (TTS) is an acute heart failure syndrome characterised by catecholamine-induced oxidative tissue damage. Punica granatum, a fruit-bearing tree, is known to have high polyphenolic content and has been proven to be a potent antioxidant. This study aimed to investigate the effects of pomegranate peel extract (PoPEx) pre-treatment on isoprenaline-induced takotsubo-like myocardial injury in rats. Male Wistar rats were randomised into four groups. Animals in the PoPEx(P) and PoPEx + isoprenaline group (P + I) were pre-treated for 7 days with 100 mg/kg/day of PoPEx. On the sixth and the seventh day, TTS-like syndrome was induced in rats from the isoprenaline(I) and P + I groups by administering 85 mg/kg/day of isoprenaline. PoPEx pre-treatment led to the elevation of superoxide dismutase and catalase (p < 0.05), reduced glutathione (p < 0.001) levels, decreased the thiobarbituric acid reactive substances (p < 0.001), H2O2, O2- (p < 0.05), and NO2- (p < 0.001), in the P + I group, when compared to the I group. In addition, a significant reduction in the levels of cardiac damage markers, as well as a reduction in the extent of cardiac damage, was found. In conclusion, PoPEx pre-treatment significantly attenuated the isoprenaline-induced myocardial damage, primarily via the preservation of endogenous antioxidant capacity in the rat model of takotsubo-like cardiomyopathy.
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Affiliation(s)
- Sonja T Marinković
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Pediatric Clinic, University Clinical Centre of the Republic of Srpska, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Đorđe Đukanović
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Mladen Duran
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Zorislava Bajic
- Department of Physiology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tanja Sobot
- Department of Physiology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Snežana Uletilović
- Department of Medical Biochemistry and Chemistry, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Nebojša Mandić-Kovacević
- Department of Pharmacy, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Tanja Cvjetković
- Department of Medical Biochemistry and Chemistry, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Žana M Maksimović
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Uglješa Maličević
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Nikolina Vesić
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Sanja Jovičić
- Department of Histology and Embryology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Maja Katana
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Katarina Šavikin
- Institute for Medicinal Plants Research "Dr Josif Pančić", 11000 Belgrade, Serbia
| | - Dragan M Djuric
- Institute of Medical Physiology "Richard Burian", Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Miloš P Stojiljković
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
| | - Ranko Škrbić
- Centre for Biomedical Research, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Faculty of Medicine, University of Banja Luka, 78000 Banja Luka, The Republic of Srpska, Bosnia and Herzegovina
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Wang T, Xiong T, Yang Y, Zuo B, Chen X, Wang D. Metabolic remodeling in takotsubo syndrome. Front Cardiovasc Med 2022; 9:1060070. [PMID: 36505375 PMCID: PMC9729286 DOI: 10.3389/fcvm.2022.1060070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 11/08/2022] [Indexed: 11/25/2022] Open
Abstract
The heart requires a large and constant supply of energy that is mainly the result of an efficient metabolic machinery that converges on mitochondrial oxidative metabolism to maintain its continuous mechanical work. Perturbations in these metabolic processes may therefore affect energy generation and contractile function directly. Metabolism characteristics in takotsubo syndrome (TTS) reveals several metabolic alterations called metabolic remodeling, including the hyperactivity of sympathetic metabolism, derangements of substrate utilization, effector subcellular dysfunction and systemic metabolic disorders, ultimately contributing to the progression of the disease and the development of a persistent and long-term heart failure (HF) phenotype. In this review, we explore the current literature investigating the pathological metabolic alterations in TTS. Although the metabolic dysfunction in takotsubo hearts is initially recognized as a myocardial metabolic inflexibility, we suggest that the widespread alterations of systemic metabolism with complex interplay between the heart and peripheral tissues rather than just cardiometabolic disorders per se account for long-term maladaptive metabolic, functional and structural impairment under this condition. Therapeutic strategies with the recent evidence from small clinical and animal researches, especially for targeting substrate utilization and/or oxidative stress, might be promising tools to improve the outcome of patients with TTS beyond that achieved with traditional sympathetic inhibition and symptomatic therapies.
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Affiliation(s)
- Ti Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Ting Xiong
- Department of Cardiology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yuxue Yang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Bangyun Zuo
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Xiwei Chen
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China
| | - Daxin Wang
- The Hospital Affiliated to Medical School of Yangzhou University (Taizhou People’s Hospital), Taizhou, Jiangsu, China,*Correspondence: Daxin Wang, ,
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Pelletti G, Leone O, Gavelli S, Rossi C, Foà A, Agostini V, Pelotti S. Sudden Unexpected Death after a mild trauma: The complex forensic interpretation of cardiac and genetic findings. Forensic Sci Int 2021; 328:111004. [PMID: 34597909 DOI: 10.1016/j.forsciint.2021.111004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 08/20/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
A 55-year-old man affected by a psychotic disorder suddenly died during a quarrel with his father. The autopsy excluded traumatic causes of death, and the cardiac examination identified a severe cardiomegaly with biventricular dilatation of very likely multifactorial origin. Toxicological and pharmacogenetic analyses excluded a fatal intoxication and identified the presence of the antipsychotic drug fluphenazine in the therapeutic range in a normal metabolizer. The screening for genetic variations highlighted a novel heterozygous single-nucleotide variant in the exon 36: c 0.4750C>A (p.Pro1584Thr) of the Ryanodine Receptor Type 2 (RYR2) gene. The mutation detected can be classified as Likely Pathogenic according to the American College of Medical Genetics and Genomics (ACMG) criteria. RYR2 variation has been associated to catecholaminergic polymorphic ventricular tachycardia (CPVT), a disease currently recognized as one of the most malignant cardiac channelopathies, expressed mostly in young patients, normally in the absence of structural heart disease. The victim late middle age, compared to juvenile onset of CPVT reported in literature, his clinical history, his structurally altered heart, circumstances at death and the absence of phenotype-related variations of dilated cardiomyopathy genes, suggested that the fatal arrhythmia could have been caused by an acquired form of dilated cardiopathy/cardiomyopathy. However, the contribution of the genetic variant to death cannot be completely ruled out, since the significance of a VUS or of a novel variant depends on the data available at the time of investigation, and should be periodically evaluated. We discuss the contribution of the structural alteration and of the variant detected, as well as the role of the molecular autopsy in forensic examination, which can make a significant contribution for inferring both cause and manner of death.
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Affiliation(s)
- Guido Pelletti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Ornella Leone
- Cardiovascular Pathology Unit, Division of Pathology, IRCCS S.Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Simone Gavelli
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
| | - Cesare Rossi
- Medical Genetics Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
| | - Alberto Foà
- Cardiology Unit, Department of Experimental Diagnostic and Specialty Medicine, IRCCS S. Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Valentina Agostini
- Cardiovascular Pathology Unit, Division of Pathology, IRCCS S.Orsola Hospital and University of Bologna, Bologna, Italy.
| | - Susi Pelotti
- Unit of Legal Medicine, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
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Atypical antipsychotics and oxidative cardiotoxicity: review of literature and future perspectives to prevent sudden cardiac death. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2021; 18:663-685. [PMID: 34527032 PMCID: PMC8390928 DOI: 10.11909/j.issn.1671-5411.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Oxidative stress is considered the principal mediator of myocardial injury under pathological conditions. It is well known that reactive oxygen (ROS) or nitrogen species (RNS) are involved in myocardial injury and repair at the same time and that cellular damage is generally due to an unbalance between generation and elimination of the free radicals due to an inadequate mechanism of antioxidant defense or to an increase in ROS and RNS. Major adverse cardiovascular events are often associated with drugs with associated findings such as fibrosis or inflammation of the myocardium. Despite efforts in the preclinical phase of the development of drugs, cardiotoxicity still remains a great concern. Cardiac toxicity due to second-generation antipsychotics (clozapine, olanzapine, quetiapine) has been observed in preclinical studies and described in patients affected with mental disorders. A role of oxidative stress has been hypothesized but more evidence is needed to confirm a causal relationship. A better knowledge of cardiotoxicity mechanisms should address in the future to establish the right dose and length of treatment without impacting the physical health of the patients.
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Mao S, Luo X, Li Y, He C, Huang F, Su C. Role of PI3K/AKT/mTOR Pathway Associated Oxidative Stress and Cardiac Dysfunction in Takotsubo Syndrome. Curr Neurovasc Res 2021; 17:35-43. [PMID: 31870264 DOI: 10.2174/1567202617666191223144715] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 11/23/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy, but the accurate cause of this syndrome is still unknown. METHODS β-adrenergic agonist isoproterenol (ISO) is used to establish the TTS rats model. TTS rats were treated with or without LY294002 or Rapamycin. The rat cardiomyoblast cell line H9C2 was subjected to infect with constitutively active Akt (myr-Akt) or dominant-negative mutant Akt (dn-Akt) and then, treated with ISO. Cell apoptosis was assessed using the Bax/ Bcl-2 ratio. In addition, reactive oxygen species (ROS) levels were measured using dihydroethidium (DHE). Mitochondrial superoxide generation and membrane potential were assayed by MitoSOX and JC-1 fluorescence intensity. RESULTS ISO might induce the erratic acute cardiac dysfunction and overexpression of PI3K/AKT/mTOR. Moreover, it also increased the oxidative stress and apoptosis in TTS rats. The Akt inhibitor significantly reversed the cardiac injury effect, which triggered by ISO treatment. In H9C2 cells, the inhibition of Akt provides a protective role against ISO-induced injury by reducing oxidative stress, apoptosis and mitochondrial dysfunction. CONCLUSION This study provided new insight into the protective effects of myocardial dysfunction in TTS rats via chronic inhibition of the PI3K/AKT/mTOR expression, which could reduce mitochondrial ROS and oxidative stress-induced apoptosis. PI3K/AKT/mTOR inhibitor could be a therapeutic target to treat cardiovascular dysfunction induced by stress cardiomyopathy.
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Affiliation(s)
- Shan Mao
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Hubei, 442000, China
| | - Xianghong Luo
- Department of Anesthesiology, Taihe Hospital, Hubei University of Medicine, Hubei, 442000, China
| | - Yu Li
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Hubei, 442000, China
| | - Chaorong He
- Department of Cardiology, Taihe Hospital, Hubei University of Medicine, Hubei, 442000, China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, JiangSu, 210006, China
| | - Cunhua Su
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, JiangSu, 210006, China
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Sessa F, Esposito M, Messina G, Di Mizio G, Di Nunno N, Salerno M. Sudden Death in Adults: A Practical Flow Chart for Pathologist Guidance. Healthcare (Basel) 2021; 9:870. [PMID: 34356248 PMCID: PMC8307931 DOI: 10.3390/healthcare9070870] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/06/2021] [Accepted: 07/08/2021] [Indexed: 12/27/2022] Open
Abstract
The medico-legal term "sudden death (SD)" refers to those deaths that are not preceded by significant symptoms. SD in apparently healthy individuals (newborn through to adults) represents a challenge for medical examiners, law enforcement officers, and society as a whole. This review aims to introduce a useful flowchart that should be applied in all cases of SD. Particularly, this flowchart mixes the data obtained through an up-to-date literature review and a revision of the latest version of guidelines for autopsy investigation of sudden cardiac death (SCD) in order to support medico-legal investigation. In light of this review, following the suggested flowchart step-by-step, the forensic pathologist will be able to apply all the indications of the scientific community to real cases. Moreover, it will be possible to answer all questions relative to SD, such as: death may be attributable to cardiac disease or to other causes, the nature of the cardiac disease (defining whether the mechanism was arrhythmic or mechanical), whether the condition causing SD may be inherited (with subsequent genetic counseling), the assumption of toxic or illicit drugs, traumas, and other unnatural causes.
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Affiliation(s)
- Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Massimiliano Esposito
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy;
| | - Giulio Di Mizio
- Forensic Medicine, Department of Law, Economy and Sociology, Campus “S. Venuta”, Magna Graecia University, 88100 Catanzaro, Italy;
| | - Nunzio Di Nunno
- Department of History, Society and Studies on Humanity, University of Salento, 73100 Lecce, Italy;
| | - Monica Salerno
- Department of Medical, Surgical and Advanced Technologies “G.F. Ingrassia”, University of Catania, 95121 Catania, Italy; (M.E.); (M.S.)
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Yin J, Wang S, Liu Y, Chen J, Li D, Xu T. Coronary microvascular dysfunction pathophysiology in COVID-19. Microcirculation 2021; 28:e12718. [PMID: 34013612 PMCID: PMC8236988 DOI: 10.1111/micc.12718] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/18/2021] [Accepted: 05/11/2021] [Indexed: 12/16/2022]
Abstract
Recently, accumulating evidence has highlighted the role of endothelial dysfunction in COVID-19 progression. Coronary microvascular dysfunction (CMD) plays a pivotal role in cardiovascular disease (CVD) and CVD-related risk factors (eg, age, gender, hypertension, diabetes mellitus, and obesity). Equally, these are also risk factors for COVID-19. The purpose of this review was to explore CMD pathophysiology in COVID-19, based on recent evidence. COVID-19 mechanisms were reviewed in terms of imbalanced renin-angiotensin-aldosterone-systems (RAAS), systemic inflammation and immune responses, endothelial dysfunction, and coagulatory disorders. Based on these mechanisms, we addressed CMD pathophysiology within the context of COVID-19, from five perspectives. The first was the disarrangement of local RAAS and Kallikrein-kinin-systems attributable to SARS-Cov-2 entry, and the concomitant decrease in coronary microvascular endothelial angiotensin I converting enzyme 2 (ACE2) levels. The second was related to coronary microvascular obstruction, induced by COVID-19-associated systemic hyper-inflammation and pro-thrombotic state. The third was focused on how pneumonia/acute respiratory distress syndrome (ARDS)-related systemic hypoxia elicited oxidative stress in coronary microvessels and cardiac sympathetic nerve activation. Fourthly, we discussed how autonomic nerve dysfunction mediated by COVID-19-associated mental, physical, or physiological factors could elicit changes in coronary blood flow, resulting in CMD in COVID-19 patients. Finally, we analyzed reciprocity between the coronary microvascular endothelium and perivascular cellular structures due to viremia, SARS-CoV-2 dissemination, and systemic inflammation. These mechanisms may function either consecutively or intermittently, finally culminating in CMD-mediated cardiovascular symptoms in COVID-19 patients. However, the underlying molecular pathogenesis remains to be clarified.
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Affiliation(s)
- Jie Yin
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Shaoshen Wang
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Yang Liu
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Junhong Chen
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
| | - Dongye Li
- Institute of Cardiovascular Disease Research, Xuzhou Medical University, Xuzhou, China
| | - Tongda Xu
- Department of Cardiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou, China
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Markwerth P, Bajanowski T, Tzimas I, Dettmeyer R. Sudden cardiac death-update. Int J Legal Med 2021; 135:483-495. [PMID: 33349905 PMCID: PMC7751746 DOI: 10.1007/s00414-020-02481-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Abstract
Sudden cardiac death (SCD) is one of the most common causes of death worldwide with a higher frequency especially in the young. Therefore, SCD is represented frequently in forensic autopsy practice, whereupon pathological findings in the heart can explain acute death. These pathological changes may not only include myocardial infarction, coronary thrombosis, or all forms of myocarditis/endocarditis but also rare diseases such as hereditary structural or arrythmogenic anomalies, lesions of the cardiac conduction system, or primary cardiac tumours.
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Affiliation(s)
- P Markwerth
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - T Bajanowski
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - I Tzimas
- Institute for Forensic Medicine, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - R Dettmeyer
- Institute for Forensic Medicine, University Hospital Gießen, Giessen, Germany
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11
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Duval I, Doberentz E, Madea B. Fatal bleeding after transfemoral coronary angiography in anorexia nervosa. Forensic Sci Med Pathol 2021; 17:501-505. [PMID: 33538955 DOI: 10.1007/s12024-021-00354-4] [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] [Accepted: 01/01/2021] [Indexed: 12/30/2022]
Abstract
In 2015, 911,841 left heart catheterizations and 365,038 percutaneous coronary interventions were carried out in Germany. Complication rates for elective cardiac catheterization are low; however, the risk of complications increases with patient age and comorbidity. We present the case of a 49-year-old woman with long-term anorexia nervosa who underwent a diagnostic left heart catheterization on suspicion of takotsubo cardiomyopathy (TTC). She was found with extended hemorrhage from the puncture site approximately 3.5 h after the procedure. Autopsy identified fatal bleeding as the cause of death. Clinical examinations, autopsy findings, and forensic follow-up examinations revealed no pre-existing conditions that could have contributed to fatal bleeding. Anorexia nervosa is an eating disorder with a high mortality rate. Suicide is one of the most frequent causes of death among anorexia nervosa patients. Considering the patient's history of psychiatric problems and previous suicidal utterances, we assume that she manipulated her pressure bandage with suicidal intent.
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Affiliation(s)
- Inga Duval
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany.
| | - Elke Doberentz
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
| | - Burkhard Madea
- Institute of Legal Medicine, University Hospital Bonn, Stiftsplatz 12, 53111, Bonn, Germany
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Tettamanti C, Bonsignore A, Vallega Bernucci Du Tremoul L, De Stefano F, Ventura F. Philemon and Baucis deaths: A case of two siblings and state of the art. MEDICINE, SCIENCE, AND THE LAW 2021; 61:82-87. [PMID: 33591869 DOI: 10.1177/0025802420936539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The simultaneous discovery of two corpses at the same scene obliges the forensic pathologist to consider many circumstances. First, the hypothesis of homicide/crime has to be investigated. However, when the circumstances, autopsy, histological data and toxicological and biochemical analyses suggest a natural cause of death, Philemon and Baucis syndrome should be considered. While a few cases of Philemon and Baucis deaths involving couples of spouses have been reported in the literature, only one paper describes the simultaneous deaths of two siblings. The case presented here concerns the death of two siblings who were found in an advanced stage of decomposition in their apartment, which had been allocated to them by social services. The victims were known to be living in conditions of social and economic deprivation and to be suffering from psychiatric disorders. The first suspected cause of death was malnutrition. However, this was excluded by complete autopsy, histological studies and, especially, biochemical investigations, which excluded starvation ketoacidosis. Moreover, no evidence of trauma or poisoning was found in either of the bodies. Despite the advanced stage of decomposition, one of the bodies presented with histological signs of myocardial sclerosis, left ventricular hypertrophy and contraction band necrosis, suggesting that the mechanism of death involved a fatal arrhythmia. The circumstances and the post-mortem findings were highly suggestive of Philemon and Baucis syndrome.
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Affiliation(s)
| | | | | | | | - Francesco Ventura
- Department of Legal and Forensic Medicine, University of Genova, Italy
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13
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Nootkatone, a Dietary Fragrant Bioactive Compound, Attenuates Dyslipidemia and Intramyocardial Lipid Accumulation and Favorably Alters Lipid Metabolism in a Rat Model of Myocardial Injury: An In Vivo and In Vitro Study. Molecules 2020; 25:molecules25235656. [PMID: 33266249 PMCID: PMC7730250 DOI: 10.3390/molecules25235656] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/07/2020] [Accepted: 11/11/2020] [Indexed: 12/17/2022] Open
Abstract
In the present study, we assessed whether nootkatone (NKT), a sesquiterpene in edible plants, can provide protection against dyslipidemia, intramyocardial lipid accumulation, and altered lipid metabolism in a rat model of myocardial infarction (MI) induced by subcutaneous injections of isoproterenol (ISO, 85 mg/kg) on days 9 and 10. The rats were pre- and co-treated with NKT (10 mg/kg, p.o.) administered daily for 11 days. A significant reduction in the activities of myocardial creatine kinase and lactate dehydrogenase, as well as non-enzymatic antioxidants, and alterations in lipids and lipoproteins, along with a rise in plasma lipid peroxidation and intramyocardial lipid accumulation, were observed in ISO-treated rats. ISO administration induced alterations in the activities of enzymes/expressions that played a significant role in altering lipid metabolism. However, NKT treatment favorably modulated all biochemical and molecular parameters altered by ISO and showed protective effects against oxidative stress, dyslipidemia, and altered lipid metabolism, attributed to its free-radical-scavenging and antihyperlipidemic activities in rats with ISO-induced MI. Additionally, NKT decreased the accumulation of lipids in the myocardium as evidenced from Oil red O staining. Furthermore, the in vitro observations demonstrate the potent antioxidant property of NKT. The present study findings are suggestive of the protective effects of NKT on dyslipidemia and the underlying mechanisms. Based on our findings, it can be suggested that NKT or plants rich in NKT can be promising for use as a phytopharmaceutical or nutraceutical in protecting the heart and correcting lipid abnormalities and dyslipidemia, which are risk factors for ischemic heart diseases.
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Câmara N, Sierra E, Fernández A, Arbelo M, Andrada M, Monteros AEDL, Herráez P. Increased Plasma Cardiac Troponin I in Live-Stranded Cetaceans: Correlation with Pathological Findings of Acute Cardiac Injury. Sci Rep 2020; 10:1555. [PMID: 32005888 PMCID: PMC6994679 DOI: 10.1038/s41598-020-58497-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 01/13/2020] [Indexed: 11/08/2022] Open
Abstract
Capture myopathy (CM), is a syndrome that occurs as the result of the stress during and after capture, handling, restraint, and transport of wild animals. Although CM has been described for many species of cetaceans, characterization of the acute cardiac injury - an important component of this syndrome - are still scarce. In this study, we firstly estimated a normal range for cardiac troponin I (cTnI) on cetaceans. Here, through biochemical analysis (especially of cTnI) and histopathological, histochemical, and immunohistochemical correlations with decreased troponin immunolabelling, we studied the cardiac injury in live-stranded cetaceans. Nine cetaceans which stranded alive on the Canary Islands (January 2016 - June 2019) were included in this study. Sampled individuals presented elevated values of plasma cTnI, which were correlated to histopathological lesions comprised of vascular changes and acute degenerative lesions. Immunohistochemically, injured cardiomyocytes showed a decreased intrafibrillar troponin immunoreaction. This is the first attempt to establish a normal baseline range for cTnI in cetaceans, and the first study comparing plasma biomarkers values with histopathological and immunohistochemical findings. This approach allowed us to demonstrate the degree of cardiac damage as a result of injury, consistent with ischemia-reperfusion lesions. The knowledge gained here could improve decision-making procedures during stressful situations, mainly in live-strandings, handling, and rehabilitation, thereby reducing the mortality of cetaceans.
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Affiliation(s)
- Nakita Câmara
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Sierra
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Antonio Fernández
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Arbelo
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marisa Andrada
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio Espinosa de Los Monteros
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Herráez
- Veterinary Histology and Pathology. Institute of Animal Health and Food Safety (IUSA). Veterinary School. University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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15
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Capture Myopathy and Stress Cardiomyopathy in a Live-Stranded Risso's Dolphin ( Grampus griseus) in Rehabilitation. Animals (Basel) 2020; 10:ani10020220. [PMID: 32013196 PMCID: PMC7070958 DOI: 10.3390/ani10020220] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 01/28/2023] Open
Abstract
Simple Summary Free-living cetaceans are threatened, daily, by a wide variety of stressful situations. An example is provided by live-stranding, in which a cetacean is alive on the beach or in shallow water, and unable to free itself and resume its normal activity. This is the first case of capture myopathy and stress cardiomyopathy in a live-stranded juvenile male Risso’s dolphin (Grampus griseus) with subsequent rehabilitation attempted. Valuable use of blood samples, and finally necropsy assessments, advances our understanding about the pathology common in live-stranded cetaceans. Abstract Capture myopathy (CM) is described in wild animals as a metabolic syndrome resulting from the extreme stress suffered during and after capture, handling, restraint, and transport. Although CM has been characterized in many species of cetaceans, descriptions of cardiac injury—an important component of this syndrome, and, according to previous authors, comparable to the existing human pathology so-called stress cardiomyopathy (SCMP)—are still rare. Therefore, the main aim of this report is to illustrate, for the first time, the biochemical analysis, and gross, histopathological, histochemical and immunohistochemical features of CM, and more specifically of the SCMP involved in this syndrome, caused by the live-stranding and consequent rehabilitation attempt, for a certain period of time, in a juvenile male Risso’s dolphin (Grampus griseus). The animal presented elevated values of creatine kinase, cardiac troponin I and blood urea nitrogen, with some variations during the rehabilitation period. Histologically, we detected vascular changes and acute degenerative lesions analogous to the ones observed in humans with SCMP. We consider this study to be an important contribution to the study of cetaceans since it could help in decision-making and treatment procedures during live-strandings and improve conservation efforts by reducing the mortality of these animals.
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Câmara N, Sierra E, Fernández A, Suárez-Santana CM, Puig-Lozano R, Arbelo M, Herráez P. Skeletal and Cardiac Rhabdomyolysis in a Live-Stranded Neonatal Bryde's Whale With Fetal Distress. Front Vet Sci 2019; 6:476. [PMID: 31921928 PMCID: PMC6933440 DOI: 10.3389/fvets.2019.00476] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Accepted: 12/05/2019] [Indexed: 11/13/2022] Open
Abstract
The main objective of wildlife forensic investigation is to recognize pathologic changes and cause of death. Even though it may not always be possible to determine the specific illness and/or etiology, the description and subsequent interpretation of the injuries provide an invaluable understanding of pathology in cetacean post-mortem investigations. Although pathological studies have been previously reported in various cetacean species, such descriptions of the infraorder Mysticeti remain rare. A live-stranded neonatal Bryde's whale (Balaenoptera edeni) which subsequently died soon after the stranding, was assessed by physical exam, blood examination, gross necropsy evaluation, histopathology, and immunohistochemistry. It presented with elevated serum levels of creatine kinase, cardiac troponin I, urea, and creatinine. Microscopically, we observed keratin spicules (squamous epithelial cells) and areas of atelectasis in the lungs. Acute degeneration in the myocytes and cardiomyocytes were comparable to the findings previously described in cases of capture myopathy in live-stranded cetaceans. Immunohistochemistry biomarkers such as myoglobin, fibrinogen, and troponin were analyzed. Skeletal and myocardial damage has been documented in several cetacean species. However, this is the first reported case of skeletal and cardiac rhabdomyolysis associated with live-stranding in a newborn Bryde's whale that suffered from fetal distress.
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Affiliation(s)
- Nakita Câmara
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Sierra
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Antonio Fernández
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Cristian Manuel Suárez-Santana
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Raquel Puig-Lozano
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Manuel Arbelo
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Pedro Herráez
- Department of Veterinary Histology and Pathology, Veterinary School, Institute of Animal Health and Food Safety, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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17
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Câmara N, Sierra E, Fernández-Maldonado C, Espinosa de Los Monteros A, Arbelo M, Fernández A, Herráez P. Stress cardiomyopathy in stranded cetaceans: a histological, histochemical and immunohistochemical study. Vet Rec 2019; 185:694. [PMID: 31554713 DOI: 10.1136/vr.105562] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 08/07/2019] [Accepted: 08/25/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Free-living cetaceans are exposed to a wide variety of stressful situations, including live stranding and interaction with human beings (capture myopathy), vessel strikes, and fishing activities (bycatch), which affect their wellbeing and potentially lead to stress cardiomyopathy (SCMP). METHODS Here, the authors aimed to characterise SCMP of stranded cetaceans as an injury resulting from extreme stress responses, based on pathological analyses (histological, histochemical and immunohistochemical). Specifically, the authors examined heart samples from 67 cetaceans found ashore (48 live strandings, seven dead from ship collision and 12 dead from bycatch) on the coast of Spain, more specifically in the Canary Islands from 2000 to 2016 and Andalusia from 2011 to 2014. RESULTS The microscopic findings were characterised by vascular changes, acute or subacute cardiac degenerative necrotic lesions, interstitial myoglobin globules, and infiltration of inflammatory cells. Immunohistochemically, cardiac troponin I, cardiac troponin C and myoglobin were depleted, along with fibrinogen being expressed in the degenerated/necrotic cardiomyocytes. A perivascular pattern was also identified and described in the damaged cardiomyocytes. CONCLUSIONS This study advances current knowledge about the pathologies of cetaceans and their implications on conserving this group of animals by reducing mortality and enhancing their treatment and subsequent rehabilitation to the marine environment.
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Affiliation(s)
- Nakita Câmara
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Eva Sierra
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | | | - Antonio Espinosa de Los Monteros
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Manuel Arbelo
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Antonio Fernández
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
| | - Pedro Herráez
- Departamento de Histología y Patología Animal, Instituto Universitario de Sanidad Animal y Seguridad Alimentaria (IUSA), Universidad de Las Palmas de Gran Canaria Facultad de Veterinaria, Arucas, Spain
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Baltzer Nielsen S, Stanislaus S, Saunamäki K, Grøndahl C, Banner J, Jørgensen MB. Can acute stress be fatal? A systematic cross-disciplinary review. Stress 2019; 22:286-294. [PMID: 30767612 DOI: 10.1080/10253890.2018.1561847] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
In this review it is discussed if acute stress can be fatal. The review is based on literature searches on PubMed, PsycINFO as well as Web of Science. Literature concerning the conditions excited delirium syndrome (ExDS), malignant catatonia, takotsubo cardiomyopathy (TCM), and capture myopathy (CM) is reviewed and compared. The aim of the article is to identify and discuss a possible fatalness as well as a common pathophysiology behind these conditions. This includes a deregulated autonomic nervous system, neurocardiac reasons for myocardial damage, and rhabdomyolysis. We conclude that these conditions could be different manifestations of the same pathophysiological phenomenon. In addition, we suggest that it is possible to die from acute stress, but that it requires a prior sensitization, as seen in cocaine abusers and certain psychiatric patients, to render individuals disposed to an extreme autonomic nerve reaction. Lay summary This article compares different conditions in humans and in other animals, where it appears as if the human or animal dies with no other reason than being submitted to an extreme condition of mental stress. The conditions examined via a literature search are excited delirium syndrome, malignant catatonia and takotsubo cardiomyopathy in humans, and a capture myopathy in different mammals. The article theoretically suggests that one can die solely from acute stress, but that different forms sensitization probably goes ahead of such a fatal stress reaction. E.g. in cocaine addicts, some psychiatric patients, and in wild animals formerly subjected to stress an extreme sympathetic stress response might be immediately fatal. The article also theorizes that excited delirium syndrome, malignant catatonia, and capture myopathy could be more severe and acute variants of the temporary condition seen in takotsubo patients, also known as patients with broken heart syndrome.
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Affiliation(s)
| | - Sharleny Stanislaus
- b Psychiatric Centre Copenhagen, Department O, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark
| | - Kari Saunamäki
- c Department of Cardiology, Gentofte Hospital , Copenhagen , Denmark
| | | | - Jytte Banner
- e Department of Forensic Medicine, Faculty of Health and Medical Sciences , University of Copenhagen , Copenhagen , Denmark
| | - Martin Balslev Jørgensen
- b Psychiatric Centre Copenhagen, Department O, Rigshospitalet , Copenhagen University Hospital , Copenhagen , Denmark
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Kołodzińska A, Czarzasta K, Szczepankiewicz B, Główczyńska R, Fojt A, Ilczuk T, Budnik M, Krasuski K, Folta M, Cudnoch-Jędrzejewska A, Górnicka B, Opolski G. Toll-like receptor expression and apoptosis morphological patterns in female rat hearts with takotsubo syndrome induced by isoprenaline. Life Sci 2018; 199:112-121. [PMID: 29501923 DOI: 10.1016/j.lfs.2018.02.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 02/16/2018] [Accepted: 02/28/2018] [Indexed: 11/28/2022]
Abstract
AIMS Toll-like receptors (TLR) and apoptosis were indicated as important factors in heart failure. Our aim was to characterize the morphological pattern of apoptosis, TLR2, TLR4, and TLR6 expression in female rat hearts in the model of takotsubo syndrome (TTS). MAIN METHODS 60 Sprague-Dawley female rats were treated with a single dose of 150 mg/kg b.wt. of isoprenaline (ISO) or 0.9% NaCl (controls). Hearts were collected 24, 48, 72 h and 7 days post-ISO injection. 32/60 hearts were used in immunohistopathological studies and 28/60 in real time. KEY FINDINGS Apoptosis was observed 24 h post-ISO in cardiomyocytes, 24, 48, 72 h and 7 days post-ISO in infiltrating inflammatory cells, 7 days post-ISO in endothelial cells of vessels. Diffuse TLR4CD68 (CD68, a macrophage marker) and TLR6CD68 positive cells and TLR2, TLR4, TLR6 mononuclear cells were observed in both acute and recovery phase of TTS. In the foci located in the neighborhood of damaged (necrotic/apoptotic) cardiomyocytes in TTS, high (strong) protein expression of TLR2 (TLR2high) was observed: 24, 48, 72 h post-ISO; TLR4high - 48 and 72 h post-ISO; TLR6high - 48 h post-ISO. Whereas in cardiomyocytes of remote myocardium: TLR2high - 72 h post-ISO; TLR4high - 24 and 72 h post-ISO; TLR6high - 24 h post-ISO. TLR2 mRNA was down-regulated 48 and 72 h post-ISO whereas TLR4 up-regulated 7 days post-ISO. SIGNIFICANCE The expression pattern of apoptosis and TLR differs in the course of TTS in comparison with the control rats. We hypothesize that innate immunity and apoptosis may play a crucial role in TTS pathophysiology.
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Affiliation(s)
- Agnieszka Kołodzińska
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland.
| | - Katarzyna Czarzasta
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 1b Banacha St, 02-097 Warsaw, Poland.
| | | | - Renata Główczyńska
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland.
| | - Anna Fojt
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland.
| | - Tomasz Ilczuk
- Department of Pathology, Medical University of Warsaw, 7 Pawińskiego St, 02-106 Warsaw, Poland.
| | - Monika Budnik
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland.
| | - Krzysztof Krasuski
- Department of Medical Informatics and Telemedicine, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland; Faculty of Mathematics and Information Science, Warsaw University of Technology, 75 Koszykowa St, 00-662 Warsaw, Poland.
| | - Miłosz Folta
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland; Department of Pathology, Medical University of Warsaw, 7 Pawińskiego St, 02-106 Warsaw, Poland.
| | - Agnieszka Cudnoch-Jędrzejewska
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, 1b Banacha St, 02-097 Warsaw, Poland.
| | - Barbara Górnicka
- Department of Pathology, Medical University of Warsaw, 7 Pawińskiego St, 02-106 Warsaw, Poland.
| | - Grzegorz Opolski
- First Department of Cardiology, Medical University of Warsaw, 1a Banacha St, 02-097 Warsaw, Poland.
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20
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The Role of Endogenous Opioid System in the Regulation of Heart Tolerance to Stress-Induced Damage. Bull Exp Biol Med 2017; 163:25-27. [DOI: 10.1007/s10517-017-3729-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Indexed: 10/19/2022]
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21
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Tahsili-Fahadan P, Geocadin RG. Heart-Brain Axis: Effects of Neurologic Injury on Cardiovascular Function. Circ Res 2017; 120:559-572. [PMID: 28154104 DOI: 10.1161/circresaha.116.308446] [Citation(s) in RCA: 135] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/06/2017] [Accepted: 01/06/2017] [Indexed: 01/23/2023]
Abstract
A complex interaction exists between the nervous and cardiovascular systems. A large network of cortical and subcortical brain regions control cardiovascular function via the sympathetic and parasympathetic outflow. A dysfunction in one system may lead to changes in the function of the other. The effects of cardiovascular disease on the nervous system have been widely studied; however, our understanding of the effects of neurological disorders on the cardiovascular system has only expanded in the past 2 decades. Various pathologies of the nervous system can lead to a wide range of alterations in function and structure of the cardiovascular system ranging from transient and benign electrographic changes to myocardial injury, cardiomyopathy, and even cardiac death. In this article, we first review the anatomy and physiology of the central and autonomic nervous systems in regard to control of the cardiovascular function. The effects of neurological injury on cardiac function and structure will be summarized, and finally, we review neurological disorders commonly associated with cardiovascular manifestations.
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Affiliation(s)
- Pouya Tahsili-Fahadan
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Romergryko G Geocadin
- From the Neurosciences Critical Care Division, Departments of Neurology, Anesthesiology & Critical Care Medicine, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
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Comprehensive Histological and Immunochemical Forensic Studies in Deaths Occurring in Custody. INTERNATIONAL SCHOLARLY RESEARCH NOTICES 2017; 2017:9793528. [PMID: 28386585 PMCID: PMC5366222 DOI: 10.1155/2017/9793528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 02/05/2017] [Accepted: 02/28/2017] [Indexed: 01/17/2023]
Abstract
In-custody deaths have several causes, and these include homicide, suicide, natural death from chronic diseases, and unexplained death possibly related to acute stress, asphyxia, excited delirium, and drug intoxication. In some instances, these deaths are attributed to undefined accidents and natural causes even though there is no obvious natural cause apparent after investigation. Understanding these deaths requires a comprehensive investigation, including documentation of circumstances surrounding the death, review of past medical history, drug and toxicology screens, and a forensic autopsy. These autopsies may not always clearly explain the death and reveal only nonspecific terminal events, such as pulmonary edema or cerebral edema. There are useful histologic and biochemical signatures which identify asphyxia, stress cardiomyopathy, and excited delirium. Identifying these causes of death requires semiquantitative morphologic and biochemical studies. We have reviewed recent Bureau of Justice Statistics on in-custody death, case series, and morphological and biochemical studies relevant to asphyxia, stress cardiomyopathy, and excited delirium and have summarized this information. We suggest that regional centers should manage the investigation of these deaths to provide more comprehensive studies and to enhance the expertise of forensic pathologists who would routinely manage potentially complex and difficult cases.
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Sellers RS, Pardo I, Hu G, Khan KN, Perry R, Markiewicz V, Rohde C, Colangelo J, Reagan W, Clarke D. Inflammatory Cell Findings in the Female Rabbit Heart and Stress-associated Exacerbation with Handling and Procedures Used in Nonclinical Studies. Toxicol Pathol 2017; 45:416-426. [DOI: 10.1177/0192623317700519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Despite the use of rabbits in biomedical research, including regulatory toxicology and cardiovascular studies, little data exist on heart findings in this species. This study was designed to document myocardial findings in female rabbits and the impact of study-related procedures typical for vaccine toxicology studies. One hundred and forty 6- to 8-month-old female New Zealand White rabbits were divided equally into 2 groups, high and low study procedure groups (group 1 and group 2, respectively). All animals received intramuscular (IM) injections of sterile saline every 2 weeks for 5 times and were necropsied 2 days after the final IM injection. Clinical chemistry, hematology, and urinalysis were evaluated. Blood for stress biomarkers (norepinephrine, epinephrine, cortisol, and corticosterone), C-reactive protein, cardiac troponin I, and creatine kinase were collected at time 0 (just before dose administration) and then at 4, 24, and 48 hr after dose administration in group 1 only. Hearts were assessed histologically. Focal to multifocal minimal inflammatory cell infiltrates were common (∼80%), particularly in the left ventricle and interventricular septum, and were similar to the types of infiltrates identified in other laboratory animal species. Additionally, study-related procedures elevated serum stress biomarkers and exacerbated the frequency and severity of myocardial inflammatory cell infiltrates.
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Affiliation(s)
- Rani S. Sellers
- Drug Safety Research and Development, Pfizer Inc., Pearl River, New York, USA
| | - Ingrid Pardo
- Drug Safety Research and Development, Pfizer Inc., Groton, Connecticut, USA
| | - George Hu
- Drug Safety Research and Development, Pfizer Inc., Pearl River, New York, USA
| | - K. Nasir Khan
- Drug Safety Research and Development, Pfizer Inc., Groton, Connecticut, USA
| | - Richard Perry
- Drug Safety Research and Development, Pfizer Inc., Groton, Connecticut, USA
| | | | - Cynthia Rohde
- Drug Safety Research and Development, Pfizer Inc., Pearl River, New York, USA
| | - Jennifer Colangelo
- Drug Safety Research and Development, Pfizer Inc., Groton, Connecticut, USA
| | - William Reagan
- Drug Safety Research and Development, Pfizer Inc., Groton, Connecticut, USA
| | - David Clarke
- Drug Safety Research and Development, Pfizer Inc., Pearl River, New York, USA
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Qin YJ, Zhang XL, Yu YQ, Bian XH, Dong SM. Cardioprotective effect of erythropoietin on sepsis-induced myocardial injury in rats. World J Emerg Med 2014; 4:215-22. [PMID: 25215122 PMCID: PMC4129848 DOI: 10.5847/wjem.j.issn.1920-8642.2013.03.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 07/26/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND: Sepsis-induced myocardial injury is one of the major predictors of morbidity and mortality of sepsis. The cytoprotective function of erythropoietin (EPO) has been discovered and extensively studied. However, the cardioprotective effects of EPO on sepsis-induced myocardial injury in the rat sepsis model has not been reported. METHODS: The rat models of sepsis were produced by cecal ligation and perforation (CLP) surgery. Rats were randomly (random number) assigned to one of three groups (n=8 for each group): sham group, CLP group and EPO group (1000 IU/kg erythropoietin). Arterial blood was withdrawn at 3, 6, 12, and 24 hours after CLP. cTnI, BNP, CK-MB, LDH, AST, TNF-α, IL-6, IL-10, and CRP were tested by the ELISA assay. Changes of hemodynamic parameters were recorded at 3, 6, 12, 24 hours after the surgery. Histological diagnosis was made by hematoxylin and eosin. Flow cytometry was performed to examine cell apoptosis, myocardium mitochondrial inner membrane potential, and NF-κB (p65). Survival rate at 7 days after CLP was recorded. RESULTS: In the CLP group, myocardial enzyme index and inflammatory index increased at 3, 6, 12 and 24 hours after CLP compared with the sham group, and EPO significantly blocked the increase. Compared with the CLP group, EPO significantly improved LVSP, LV +dp/dtmax, LV −dp/dtmin, and decreased LVEDP at different time. EPO blocked the reduction of mitochondrial transmembrane potential, suppressed the cardiomyocyte apoptosis, inhibited the activation of NF-κB, and reduced the production of proinflmmatory cytokines. No difference in the survival rate at 7 days was observed between the CLP group and the EPO group. CONCLUSION: Exogenous EPO has cardioprotective effects on sepsis-induced myocardial injury.
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Affiliation(s)
- Yan-Jun Qin
- Department of Emergency Medicine, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Xin-Liang Zhang
- Department of Clinical Laboratory, General Hospital of Hebei Province, Shijiazhuang 050051, China
| | - Yue-Qing Yu
- Department of Clinical Laboratory, General Hospital of Hebei Province, Shijiazhuang 050051, China
| | - Xiao-Hua Bian
- Department of Emergency Medicine, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
| | - Shi-Min Dong
- Department of Emergency Medicine, Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
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Hashimoto M, Nakajima M, Kuroda R, Yamaguchi R, Maeda H, Nagai H, Ikegaya H, Yoshida KI. Sudden unexpected death in a patient with epilepsy presenting with high N-terminal probrain natriuretic peptide level, cardiac lesions, and pulmonary edema. Int J Cardiol 2014; 172:e265-7. [DOI: 10.1016/j.ijcard.2013.12.069] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/22/2013] [Indexed: 10/25/2022]
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Szardien S, Möllmann H, Willmer M, Akashi YJ, Hamm CW, Nef HM. Mechanisms of stress (takotsubo) cardiomyopathy. Heart Fail Clin 2013; 9:197-205, ix. [PMID: 23562120 DOI: 10.1016/j.hfc.2012.12.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Stress cardiomyopathy is a form of reversible systolic dysfunction of the mid and apical left ventricle with pathologic changes of the electrocardiogram in the absence of an obstructive coronary artery disease. The prevalence of stress cardiomyopathy among patients with symptoms suggestive of myocardial infarction is 0.7% to 2.5%, and it is found predominantly in postmenopausal women (90%). No large studies have confirmed the cause of stress cardiomyopathy. Published data suggest that substantially elevated plasma catecholamine levels, due to emotional or physical stress, may be relevant.
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Affiliation(s)
- Sebastian Szardien
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestrasse 2-8, Bad Nauheim 61231, Germany.
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Kinbara T, Hayano T, Otani N, Furutani Y, Murakami T, Yano M. An autopsy case of tako-tsubo cardiomyopathy presenting ventricular tachycardia after pacemaker implantation. J Cardiol Cases 2013; 8:134-137. [PMID: 30546765 PMCID: PMC6281519 DOI: 10.1016/j.jccase.2013.06.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2013] [Revised: 06/27/2013] [Accepted: 06/30/2013] [Indexed: 11/19/2022] Open
Abstract
We herein report a rare autopsy case of tako-tsubo cardiomyopathy (TTC) presenting ventricular tachycardia after pacemaker implantation. A 69-year-old male received a dual-chamber pacemaker implantation for complete atrioventricular block. He had no chest symptoms after the operation. Three days later, he developed severe chest pain, followed by syncope. Electrocardiogram showed sustained monomorphic ventricular tachycardia. Despite the use of amiodarone and frequent electrical defibrillation, ventricular tachycardia and ventricular fibrillation were repeated incessantly. He died 24 h after the syncope. The autopsy revealed no hemopericardial effusion, or perforation of leads. There were also no obstructive lesions in the coronary arteries. Myocardial necrosis was observed in the entire circumference and the all layers of the left ventricle. Microscopically, myocardial necrosis was plurifocal and contraction band necrosis. We speculate that catecholamine cardiotoxicity caused ventricular tachycardia in this case. Further studies are needed to clarify the heterogeneity of this disease. .
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Affiliation(s)
- Terufumi Kinbara
- Department of Cardiology, National Hospital Organization, Kanmon Medical Center, 1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi 752-8510, Japan
| | - Tomoko Hayano
- Department of Cardiology, National Hospital Organization, Kanmon Medical Center, 1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi 752-8510, Japan
| | - Nozomu Otani
- Department of Cardiology, National Hospital Organization, Kanmon Medical Center, 1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi 752-8510, Japan
| | - Yuhji Furutani
- Department of Cardiology, National Hospital Organization, Kanmon Medical Center, 1-1 Chofusotoura-cho, Shimonoseki, Yamaguchi 752-8510, Japan
| | - Tomoyuki Murakami
- Department of Pathology, National Hospital Organization, Kanmon Medical Center, Yamaguchi 752-8510, Japan
| | - Masafumi Yano
- Department of Medicine and Clinical Science, Division of Cardiology, Yamaguchi University Graduate School of Medicine, Ube, Yamaguchi 755-8505, Japan
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Savall F, Dedouit F, Telmon N, Rougé D. Takotsubo Cardiomyopathy in a Jeweler Following a Hold-up: Forensic Considerations. J Forensic Sci 2013; 58:1648-50. [DOI: 10.1111/1556-4029.12207] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 08/07/2012] [Accepted: 08/18/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Frederic Savall
- Service de Médecine Légale; Centre Hospitalier Universitaire Rangueil; Avenue du Professeur Jean Poulhès 31059 Toulouse Cedex 9 France
| | - Fabrice Dedouit
- Service de Médecine Légale; Centre Hospitalier Universitaire Rangueil; Avenue du Professeur Jean Poulhès 31059 Toulouse Cedex 9 France
- Service de Radiologie; Centre Hospitalier Universitaire Rangueil; Avenue du Professeur Jean Poulhès 31059 Toulouse Cedex 9 France
| | - Norbert Telmon
- Service de Médecine Légale; Centre Hospitalier Universitaire Rangueil; Avenue du Professeur Jean Poulhès 31059 Toulouse Cedex 9 France
| | - Daniel Rougé
- Service de Médecine Légale; Centre Hospitalier Universitaire Rangueil; Avenue du Professeur Jean Poulhès 31059 Toulouse Cedex 9 France
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Shao Y, Redfors B, Scharin Täng M, Möllmann H, Troidl C, Szardien S, Hamm C, Nef H, Borén J, Omerovic E. Novel rat model reveals important roles of β-adrenoreceptors in stress-induced cardiomyopathy. Int J Cardiol 2013; 168:1943-50. [PMID: 23357048 DOI: 10.1016/j.ijcard.2012.12.092] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2012] [Revised: 12/06/2012] [Accepted: 12/27/2012] [Indexed: 01/22/2023]
Abstract
BACKGROUND Stress-induced cardiomyopathy (SIC), also known as Takotsubo cardiomyopathy, is an acute cardiac syndrome with substantial morbidity and mortality. The unique hallmark of SIC is extensive ventricular akinesia involving apical segments with preserved function in basal segments. Adrenergic overstimulation plays an important role in initiating SIC but the pathophysiological pathways and receptors involved are unknown. METHODS Sprague Dawley rats (~300 g) were injected with a single dose of the β-adrenergic agonist isoprenaline (ISO, i.p.) and echocardiography was used to study cardiac function. The akinetic part of the left ventricle was biopsied in six SIC patients. Amount of intracellular lipid and glycogen as well as degree of permanent cardiac damage were assessed by histology. RESULTS In rats, ISO at doses ≥ 50 mg/kg induced severe SIC-like regional akinesia that completely resolved within seven days. Intracellular lipid content was higher in akinetic, but not in normokinetic myocardium in both SIC patients and rats. β2-receptor blockade or Gi-pathway inhibition was associated with less widespread akinesia and low lipid accumulation but significantly increased acute mortality. CONCLUSIONS We provide a novel rat model of SIC that supports the hypothesis of circulating catecholamines as initiators of SIC. We propose that the β-adrenoreceptor pathway is important in the setting of severe catecholamine overstimulation and that perturbations of cardiac metabolism occur in SIC.
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Affiliation(s)
- Yangzhen Shao
- Wallenberg Laboratory at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Shao Y, Redfors B, Ståhlman M, Täng MS, Miljanovic A, Möllmann H, Troidl C, Szardien S, Hamm C, Nef H, Borén J, Omerovic E. A mouse model reveals an important role for catecholamine-induced lipotoxicity in the pathogenesis of stress-induced cardiomyopathy. Eur J Heart Fail 2012; 15:9-22. [PMID: 23099354 DOI: 10.1093/eurjhf/hfs161] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM Stress-induced cardiomyopathy (SIC), also known as takotsubo cardiomyopathy, is an acute cardiac syndrome with substantial morbidity and mortality. The unique hallmark of SIC is extensive ventricular dysfunction (akinesia) involving apical segments with preserved function in basal segments. Adrenergic overstimulation plays an important role in initiating SIC, but the pathomechanisms involved are unknown. We tested the hypothesis that excessive catecholamines cause perturbation of myocardial lipid metabolism and that cardiac lipotoxicity is responsible for the pathogenesis of SIC. METHODS AND RESULTS A single dose injection of isoprenaline (ISO; 400 mg/kg) induced SIC-like regional akinesia in mice. Oil red O staining revealed severe lipid accumulation in the heart 2 h post-ISO. Both intramyocardial lipid accumulation and cardiac function were normalized within 1 week post-ISO and no significant amount of fibrosis was detected. We found that gene expression of lipid importers and exporters (ApoB lipoprotein) was depressed 2 h post-ISO. These results were confirmed by similar findings in SIC patients and in ISO/patient serum-stressed HL-1 cardiomyocytes. Moreover, overexpression of ApoB in the heart was found to protect against the development of ISO-induced cardiac toxicity and cardiac dysfunction. We also found that ISO-induced intramyocardial lipid accumulation caused electrophysiological disturbance and stunning in ISO/patient serum-stressed HL-1 cardiomyocytes. CONCLUSIONS The present study demonstrates that lipotoxicity is closely associated with catecholamine-induced myocardial dysfunction, including neurogenic stunning, metabolic stunning, and electrophysiological stunning. Cardiac lipotoxicity may originate from direct inhibition of myocardial ApoB lipoprotein and subsequent decreased lipid export, caused by supraphysiological levels of catecholamines.
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Affiliation(s)
- Yangzhen Shao
- Wallenberg Laboratory at Sahlgrenska Academy, Göteborg University Göteborg, Sweden.
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Turillazzi E, Bello S, Neri M, Riezzo I, Fineschi V. Colloid cyst of the third ventricle, hypothalamus, and heart: a dangerous link for sudden death. Diagn Pathol 2012; 7:144. [PMID: 23078815 PMCID: PMC3502434 DOI: 10.1186/1746-1596-7-144] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 10/08/2012] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Colloid cysts are rare congenital, intracranial neoplasms, commonly located in the third ventricle. Colloid cysts are endodermal congenital malformations. The cysts commonly range in size from 1-2 cm in diameter, although large cysts >3 cm in size have been reported. The components of the cyst include an outer fibrous capsule over an inner epithelium. The epithelium is usually a single layer of mucin-producing or ciliated cells. Such cysts contain mucoid and gelatinous material, which is positive for both Periodic acid Schiff (PAS) and mucicarmen staining. Although colloid cysts usually represent histopathologically benign neoplasms, they can result in sudden, unexpected and potentially lethal complications. The mechanism(s) of death is still a controversial subject and several mechanisms have been postulated to explain the sudden onset of severe symptoms and of fatal rapid deterioration in patients with colloid cysts. In this case, macroscopic and histological findings addressed the diagnosis of colloid cyst of the third ventricle with diffuse myocardial injury (coagulative myocytolysis or contraction band necrosis, CBN) and led us to conclude that acute cardiac arrest due to hypothalamus stimulation in the context of colloid cyst of the third ventricle was the cause of death. As the hypothalamic structures which are involved in neuroendocrine and autonomic regulation playing a key role in cardiovascular control are located close to the walls of the third ventricle which is the most frequent anatomical site of colloid cyst, this may suggest that reflex cardiac effects due to the compression of the hypothalamic cardiovascular regulatory centers by the cyst explain the sudden death in patients harboring a colloid cyst when signs of hydrocephalus or brain herniation are lacking. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4915842848034158.
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Zhang M, Tavora F, Zhang Y, Ripple M, Fowler D, Li L, Zhao Z, Burke A. The role of focal myocardial inflammation in sudden unexpected cardiac and noncardiac deaths—A clinicopathological study. Int J Legal Med 2011; 127:131-8. [DOI: 10.1007/s00414-011-0634-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 10/07/2011] [Indexed: 11/29/2022]
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Wong DL, Tai TC, Wong-Faull DC, Claycomb R, Meloni EG, Myers KM, Carlezon WA, Kvetnansky R. Epinephrine: a short- and long-term regulator of stress and development of illness : a potential new role for epinephrine in stress. Cell Mol Neurobiol 2011; 32:737-48. [PMID: 22090159 DOI: 10.1007/s10571-011-9768-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2011] [Accepted: 10/31/2011] [Indexed: 01/24/2023]
Abstract
Epinephrine (Epi), which initiates short-term responses to cope with stress, is, in part, stress-regulated via genetic control of its biosynthetic enzyme, phenylethanolamine N-methyltransferase (PNMT). In rats, immobilization (IMMO) stress activates the PNMT gene in the adrenal medulla via Egr-1 and Sp1 induction. Yet, elevated Epi induced by acute and chronic stress is associated with stress induced, chronic illnesses of cardiovascular, immune, cancerous, and behavioral etiologies. Major sources of Epi include the adrenal medulla and brainstem. Although catecholamines do not cross the blood-brain barrier, circulating Epi from the adrenal medulla may communicate with the central nervous system and stress circuitry by activating vagal nerve β-adrenergic receptors to release norepinephrine, which could then stimulate release of the same from the nucleus tractus solitarius and locus coeruleus. In turn, the basal lateral amygdala (BLA) may activate to stimulate afferents to the hypothalamus, neocortex, hippocampus, caudate nucleus, and other brain regions sequentially. Recently, we have shown that repeated IMMO or force swim stress may evoke stress resiliency, as suggested by changes in expression and extinction of fear memory in the fear-potentiated startle paradigm. However, concomitant adrenergic changes seem stressor dependent. Present studies aim to identify stressful conditions that elicit stress resiliency versus stress sensitivity, with the goal of developing a model to investigate the potential role of Epi in stress-associated illness. If chronic Epi over expression does elicit illness, possibilities for alternative therapeutics exist through regulating stress-induced Epi expression, adrenergic receptor function and/or corticosteroid effects on Epi, adrenergic receptors and the stress axis.
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Affiliation(s)
- Dona Lee Wong
- Department of Psychiatry, Harvard Medical School, MA, USA.
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Bello S, Neri M, Riezzo I, Othman MS, Turillazzi E, Fineschi V. Cardiac beriberi: morphological findings in two fatal cases. Diagn Pathol 2011; 6:8. [PMID: 21244717 PMCID: PMC3034660 DOI: 10.1186/1746-1596-6-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2010] [Accepted: 01/19/2011] [Indexed: 11/10/2022] Open
Abstract
Cardiovascular beriberi is categorized into two main groups, according to its cause: alcoholic and non-alcoholic (dietary). Cardiovascular beriberi can also be divided into a fulminant form (Shoshin beriberi) and a chronic form. Shoshin beriberi is characterized by hypotension, tachycardia, and lactic acidosis and is mainly encountered in non-alcoholic patients in Asian countries, although it has also been seen in alcoholics in Western countries. Due to the complex clinical presentation and to the lack of diagnostic tests, thiamine deficiency is still being missed, especially among non-alcoholics patients. We present two fatal cases of non - alcohol associated cardiac beriberi. An acute myocardial infarction was observed in one case; extensive colliquative myocytolisis (grade 2) was described in the second case respectively. Morphologically, myocardial necrosis and colliquative myocytolysis are the histologic hallmarks of this acute, rare clinical entity. An increase in apoptotic myocytes was demonstrated probably sustaining the cardiogenic shock.
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Affiliation(s)
- Stefania Bello
- Department of Forensic Pathology, University of Foggia, Foggia, Italy
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Current World Literature. Curr Opin Cardiol 2011; 26:71-8. [DOI: 10.1097/hco.0b013e32834294db] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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D'Errico S, Neri M, Nieddu A, Mazzeo E, Riezzo I, Turillazzi E, Fineschi V. Cardiac β1-adrenoceptor expression in two stress-induced cardiomyopathy-related deaths. Forensic Sci Int 2010; 207:e8-11. [PMID: 21159454 DOI: 10.1016/j.forsciint.2010.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2010] [Revised: 10/16/2010] [Accepted: 11/18/2010] [Indexed: 11/26/2022]
Abstract
Stress-induced cardiomyopathy (SICM) is characterized by transient systolic dysfunction of the apical and/or midventricular myocardial segments in the absence of obstructive coronary artery disease and is unique in that it can manifest itself after acute emotional stress. Excessive amounts of catecholamines released from sympathetic nerve endings as well as from the adrenal medulla under stressful conditions are considered to produce intracellular Ca(2+) overload and cardiac dysfunction through the β(1)-adrenoceptor signal transduction pathway. We describe the clinical and pathomorphological findings in two stress-induced cardiomyopathy fatal cases. Levels of catecholamines and their metabolites in urine samples were assessed too. Morphological patterns seen in SICM result from the complex interplay between sympathetic innervations, β-receptor density and function and catecholamine sensitivity.
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Affiliation(s)
- Stefano D'Errico
- Department of Forensic Pathology, University of Foggia, Ospedale Colonnello D'Avanzo, Viale degli Aviatori 1, 71100 Foggia, Italy
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