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Tran NQ, Tran HTN, Tran TV, Nguyen TT. An Undetected Pheochromocytoma Leading to Fulminant Adrenergic Myocarditis Complicated by Cardiogenic Shock. JCEM CASE REPORTS 2023; 1:luad142. [PMID: 38045867 PMCID: PMC10690852 DOI: 10.1210/jcemcr/luad142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Indexed: 12/05/2023]
Abstract
Pheochromocytomas are rare catecholamine-secreting neuroendocrine tumors. Their episodic nature is correlated with abrupt catecholamine release and clinical manifestations that mimic other vascular conditions, leading to delayed diagnosis and potentially life-threatening complications, such as acute myocarditis and pheochromocytoma crises. In this report, we described the case of fulminant adrenergic myocarditis-induced cardiogenic shock requiring extracorporeal membrane oxygenation support in a Vietnamese middle-aged man with a 5-year history of Brugada syndrome, hypertension, and previously undiagnosed pheochromocytoma. After stabilization, the patient was medically treated with a combination of α- and β-blockers before undergoing laparoscopic right adrenalectomy.
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Affiliation(s)
- Nam Q Tran
- Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
| | - Hieu T N Tran
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
| | - Thang V Tran
- Department of Endocrinology, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
| | - Thuan T Nguyen
- Department of Endocrinology, University Medical Center at Ho Chi Minh City, Ho Chi Minh City, 700000, Viet Nam
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Kyuno D, Tateno M, Ono Y, Magara K, Takasawa K, Takasawa A, Osanai M. Common pathological findings in the heart in COVID-19-related sudden death cases: An autopsy case series. Heliyon 2023; 9:e20564. [PMID: 37842587 PMCID: PMC10568345 DOI: 10.1016/j.heliyon.2023.e20564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 09/18/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023] Open
Abstract
Background Cardiomyopathy is a leading cause of sudden out-of-hospital death after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) vaccination. Such unexpected COVID-19-related cardiomyopathies are challenging to diagnose as specific pathological findings are not always identified. Case summary We reported the autopsy findings of two cases of sudden death due to COVID-19-related cardiomyopathies. In one case, death occurred after SARS-CoV-2 infection, while in the other, after COVID-19 vaccination. We found common pathological findings in both hearts: decreased staining intensity with special stains, loss of rhabdomeres, and multivacuolation in cardiomyocytes without inflammatory cell infiltration. The remaining organs showed no findings that could have contributed to the deaths. Conclusion In cases of sudden death after SARS-CoV-2 infection or COVID-19 vaccination, the decreased staining intensity with special stains may aid the diagnosis of sudden death due to COVID-19-related cardiomyopathy, even when H&E staining shows few findings.
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Affiliation(s)
- Daisuke Kyuno
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Masatoshi Tateno
- Department of Surgical Pathology, Kushiro Red Cross Hospital, Kushiro, Japan
| | - Yusuke Ono
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Kazufumi Magara
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Kumi Takasawa
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Akira Takasawa
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
| | - Makoto Osanai
- Department of Pathology, Sapporo Medical University, Sapporo, Japan
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3
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Argenta FF, Slaviero M, de Mello LS, Echenique JVZ, Zorzan AA, Cony FG, Bandinelli MB, de Castro MB, Pavarini SP, Driemeier D, Sonne L. Pathological Aspects and Immunohistochemical Evaluation of Troponin C in the Cardiovascular System of Dogs with Pheochromocytoma. Top Companion Anim Med 2023; 53-54:100777. [PMID: 37030618 DOI: 10.1016/j.tcam.2023.100777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 03/23/2023] [Accepted: 03/23/2023] [Indexed: 04/08/2023]
Abstract
Functional pheochromocytomas secrete catecholamines and have been associated with cardiovascular lesions in dogs. This study aimed to describe the post-mortem pathological findings in the cardiovascular system of dogs with pheochromocytoma and to evaluate the expression of cardiac troponin C in these dogs using immunohistochemical analysis. Twelve cases were identified, with a mean age of 10.6 years. The heart of all dogs was enlarged and with concentric hypertrophy of the left ventricular myocardium. Histological analysis showed cardiomyocyte necrosis and degeneration in the myocardium, with frequent bands of contraction, fibrosis, inflammation, and thickening of the medium-calibre arteries in the myocardium. There was a marked decrease or absence of immunolabeling in necrotic cardiomyocytes. We conclude that IHC for troponin C can be a useful tool for detecting myocardial necrosis in dogs with pheochromocytomas, including early cases of necrosis with only incipient cardiac changes where overt histologic abnormalities are not immediately apparent in the cardiomyocytes.
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Affiliation(s)
- Fernando F Argenta
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Mônica Slaviero
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
| | - Lauren S de Mello
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Joanna V Z Echenique
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Alexia A Zorzan
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Fernanda G Cony
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Marcele B Bandinelli
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Márcio B de Castro
- Department of Veterinary Pathology, College of Agronomy and Veterinary Medicine, Universidade de Brasília, Brasília, DF, Brazil
| | - Saulo P Pavarini
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - David Driemeier
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
| | - Luciana Sonne
- Department of Veterinary Pathology, College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil
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Yu Y, Chen C, Han W, Zhang Y, Zhang Z, Yang Y. Metanephrine and normetanephrine associated with subclinical myocardial injuries in pheochromocytoma and paraganglioma. Front Oncol 2022; 12:1024342. [PMID: 36237312 PMCID: PMC9552905 DOI: 10.3389/fonc.2022.1024342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/12/2022] [Indexed: 11/29/2022] Open
Abstract
Objective To analyze the correlation between metanephrine and normetanephrines (MNs) and subclinical myocardial injuries (SMI) diagnosed by low left ventricular global longitudinal strain (LV GLS) in patients with pheochromocytoma and paraganglioma (PPGL). Methods Seventy-six patients who underwent surgery for pheochromocytoma or paraganglioma from September 2017 to April 2022 were examined. All the patients enrolled had normal left ventricular ejection fraction (LVEF) and myocardial injury biomarkers including cardiac troponin I and B-natriuretic peptide. Univariate analysis and multivariate analysis were performed to evaluate the association of MNs and subclinical myocardial injury (SMI)(defined as LV GLS<18). Results LV GLS of 13(17.11%) PPGL patients was less than 18. The percentage of patients with elevation of single hormone (metanephrine, normetanephrine, 3-methoxytyramine) or any one of MNs was not significantly correlated with SMI (P=0.987, 0.666, 0.128 and 0.918, respectively). All MNs elevation was associated with SMI (OR: 11.27; 95% CI, 0.94—135.24; P= 0.056). After adjusting for age, All MNs elevation was significantly correlated with SMI (OR: 16.54; 95% CI, 1.22—223.62; P= 0.035). Conclusion MNs might be an important factor influencing myocardial function. All MNs elevation might indicate SMI. If all MNs elevated, LV GLS measurement was recommended for PPGL patients to detect SMI in the absence of decrease LVEF or other heart disease in clinical practice.
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Affiliation(s)
- Yang Yu
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Chuyun Chen
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Wencong Han
- Department of Urology, Peking University First Hospital, Beijing, China
| | - Yan Zhang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Zheng Zhang
- Department of Urology, Peking University First Hospital, Beijing, China
- Institute of Urology, Peking University, Beijing, China
- National Urological Cancer Center, Peking University First Hospital, Beijing, China
- *Correspondence: Zheng Zhang, ; Ying Yang,
| | - Ying Yang
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Echocardiography Core Lab, Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
- *Correspondence: Zheng Zhang, ; Ying Yang,
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Y-Hassan S, Falhammar H. Cardiovascular Manifestations and Complications of Pheochromocytomas and Paragangliomas. J Clin Med 2020; 9:jcm9082435. [PMID: 32751501 PMCID: PMC7465968 DOI: 10.3390/jcm9082435] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 12/13/2022] Open
Abstract
Pheochromocytomas and paragangliomas (PPGLs) are rare neuro-endocrine tumors. The catecholamine surge causes paroxysmal or chronic secondary hypertension. PPGLs may present as hypertensive- or PPGL-crisis with severe life-threatening cardiac and cerebrovascular complications. PPGLs-induced cardiac manifestations have been reported with diagnoses as PPGLs-induced electrocardiogram (ECG) changes “mimicking acute myocardial infarction”, arrhythmias, myocarditis, acute coronary syndrome, dilated cardiomyopathy, and lately as takotsubo syndrome. Critical analysis of these reports reveals that most of these cardiac manifestations have certain features in common. They have a dramatic clinical presentation and are reversible if the disease is treated with appropriate medical therapy and surgical resection of the PPGL tumor. They may have the same repolarization ECG changes irrespective of the clinical cardiac diagnosis, usually associated with mild to moderate elevations of myocardial biomarkers as troponins and normal coronary arteries. The histopathological findings are usually focal or multifocal in the form hypercontracted sarcomeres and contraction band necrosis (myofibrillar degeneration) with subsequent secondary mononuclear cell infiltration. Evidences argue the PPGL caused surge of catecholamines triggers hyperactivation of the sympathetic nervous system with cardiac sympathetic nerve terminal disruption with norepinephrine spillover causing the cardiac complications. A comprehensive review of various reported cardiovascular manifestations and complications of PPGLs are presented.
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Affiliation(s)
- Shams Y-Hassan
- Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, 141 86 Stockholm, Sweden;
| | - Henrik Falhammar
- Department of Endocrinology, Metabolism and Diabetes, Karolinska University Hospital, 141 86 Stockholm, Sweden
- Department of Molecular Medicine and Surgery, Karolinska Institutet, 171 76 Stockholm, Sweden
- Correspondence:
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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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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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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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Leone O, Agostini V, Foà A, Cerbelli B, di Gioia CRT, Aromatario M, Ciallella C, Lucena J, d'Amati G. Cardiac pathologic findings in 3 unusual cases of sudden cardiac death related to anorexiant drugs. Hum Pathol 2017; 69:101-109. [PMID: 29024685 DOI: 10.1016/j.humpath.2017.09.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/11/2017] [Accepted: 09/22/2017] [Indexed: 12/23/2022]
Abstract
Amphetamine congeners can be prescribed as anorexiant drugs despite their potential adverse effects, including cardiac toxicity. However, the morphologic features of cardiac damage related to protracted use of these compounds are unknown. We provide a detailed description of cardiac autopsy findings in 3 cases of sudden death associated with protracted use of high doses of phendimetrazine and/or phenylpropanolamine or bupropion prescribed as anorexiants, in association with other compounds. The main cardiac findings were similar in all 3 cases: (1) mild-moderate hypertrophy of the left ventricle and/or the septum; (2) myocardial nonischemic scarring (midmural and/or subepicardial) appearing as discrete foci or with a bandlike morphology; (3) mild-moderate intramural small vessel disease in the absence of significant epicardial coronary artery stenosis; and (4) acute/recent inflammatory lesions consistent with toxic myocarditis. In summary, the detailed pathology examination of the heart in these 3 cases revealed myocardial lesions identical to those reported in catecholamine myocardial damage in all their various stages of evolution. In the presence of a clinical history of long-term intake of anorexiants of this category, it is most important at autopsy to recognize and correctly interpret the acute and chronic myocardial lesions of the type herein described because they represent an anatomical substrate for arrhythmic death.
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Affiliation(s)
- Ornella Leone
- Department of Pathology, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy.
| | - Valentina Agostini
- Department of Pathology, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy
| | - Alberto Foà
- Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, S. Orsola-Malpighi University Hospital, Bologna, 40138, Italy
| | - Bruna Cerbelli
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | | | - Mariarosaria Aromatario
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | - Costantino Ciallella
- Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza, University of Rome, Rome, 00161, Italy
| | - Joaquin Lucena
- Department of Forensic Pathology, Institute of Legal Medicine and Forensic Sciences, Seville, 41015, Spain
| | - Giulia d'Amati
- Department of Radiological, Oncological and Pathological Sciences, Sapienza, University of Rome, Rome, 00161, Italy.
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