DOCSLIB.ORG

Consensus Statement on Endomyocardial Biopsy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Consensus Statement on Endomyocardial Biopsy Cardiovascular Pathology 21 (2012) 245–274 Original Article 2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology ⁎ ⁎ Ornella Leone a, , John P. Veinot b, , Annalisa Angelini c, Ulrik T. Baandrup d, Cristina Basso c, Gerald Berry e, Patrick Bruneval f, Margaret Burke g, Jagdish Butany h, Fiorella Calabrese c, Giulia d'Amati i, William D. Edwards j, John T. Fallon k, Michael C. Fishbein l, Patrick J. Gallagher m, Marc K. Halushka n, Bruce McManus o, Angela Pucci p, E. René Rodriguez q, Jeffrey E. Saffitz r, Mary N. Sheppard g, Charles Steenbergen n, James R. Stone r, Carmela Tan q, Gaetano Thiene c, Allard C. van der Wal s, Gayle L. Winters r aBologna, Italy bOttawa, Ontario, Canada cPadua, Italy dHjoerring, Denmark eStanford, CA, USA fParis, France gLondon, UK hToronto, Ontario, Canada iRome, Italy jRochester, MN, USA kNew York, NY, USA lLos Angeles, CA, USA mSouthampton, UK nBaltimore, MD, USA oVancouver, BC, Canada pPisa, Italy qCleveland, OH, USA rBoston, MA, USA sAmsterdam, The Netherlands Received 3 August 2011; received in revised form 28 September 2011; accepted 7 October 2011 Abstract The Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology have produced this position paper concerning the current role of endomyocardial biopsy (EMB) for the diagnosis of cardiac diseases and its contribution to patient management, focusing on pathological issues, with these aims: • Determining appropriate EMB use in the context of current diagnostic strategies for cardiac diseases and providing recommendations for its rational utilization ⁎ Corresponding authors. O. Leone is to be contacted at U.O. di Anatomia ed Istologia Patologica, pad. 18, Azienda Ospedaliero-Universitaria S.Orsola-Malpighi, Via Massarenti, 9, 40138 Bologna. Tel.: +39 051 6364511; fax: +39 051 6364571. J.P. Veinot, Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, ON, Canada K1H 8L6. Tel.: +1 613 737 8291; fax: +1 613 737 8712. E-mail addresses: [email protected] (O. Leone), [email protected] (J.P. Veinot). 1054-8807/11/$ – see front matter © 2012 Elsevier Inc. All rights reserved. doi:10.1016/j.carpath.2011.10.001 246 O. Leone et al. / Cardiovascular Pathology 21 (2012) 245–274 • Providing standard criteria and guidance for appropriate tissue triage and pathological analysis • Promoting a team approach to EMB use, integrating the competences of pathologists, clinicians, and imagers. © 2012 Elsevier Inc. All rights reserved. Keywords: Biopsy; Consensus; Heart; Molecular biology; Myocardium 1. Introduction standardized diagnostic histopathologic criteria to minimize EMB reporting variability [2,46,47]. Endomyocardial biopsy (EMB) is a commonly performed As EMB is usually a nontargeted biopsy procedure and procedure for the evaluation of cardiac tissue for transplant false-negative results are possible, especially when used monitoring [1,2], myocarditis [3–5], drug toxicity, cardio- for multifocal or microfocal or localized diseases [36,48,49], myopathy (CMP) [3,6–8], arrhythmia [9–14], and secondary some general rules can optimize diagnostic accuracy: cardiac involvement by systemic diseases [8], and for the diagnosis of cardiac masses [15–21]. Others have high- ■ EMB timing appropriate to specific disease [24,50,51], lighted EMB utility from prognostic–therapeutic [22–24] ■ adequate bioptic sampling with multiple specimens and pathogenetic view points [25]. from different sites (guided by imaging techniques Pathologists should assume responsibility for providing when indicated) [26,36,52,53]. input concerning the utility of the cardiac biopsy for specific diseases and provide guidance for tissue triage and standards 3. Techniques and risks of morphologic evaluation [26]. This implies considering both the recent developments in myocardial and viral EMB involves percutaneous insertion into the heart of a molecular biology and advances in imaging, electrophysio- fluoroscopically or ultrasound-directed sheath, which allows logy, and genetics, and understanding how these techniques safe and rapid insertion of the bioptome and facilitates can complement traditional histopathology. The invaluable obtaining multiple specimens. expertise of the pathologist in morphological tissue assess- Bioptic samples can be taken from the right ventricle, via ment may be essential in outlining appropriate diagnostic the venous route through jugular, subclavian, or femoral strategies in collaboration with clinicians, imagers, molec- veins, or from the left ventricle with transseptal puncture or ular biologists, and geneticists. by direct access through a peripheral artery, usually the Referral of the tissue to expert pathologists and molecular femoral or brachial artery [5,54,55]. For better anatomic biologists is warranted in many cases, given the complexity definition of the specimen site, noninvasive techniques of of the diagnostic tests. cardiac imaging may usefully be associated, such as Moreover, pathologists should endeavor to use uniform gadolinium magnetic resonance imaging (MRI) in targeting reference criteria and language in their reports, including: bioptic specimens in suspected myocarditis [56] and electroanatomic mapping guided techniques in arrhythmo- • degrees of diagnostic certainty: for example, certain– genic right ventricular cardiomyopathy (ARVC) [10,11,57]. definite, probable, possible, nonspecific; Echocardiography allows accurate intracardiac insertion of • biopsy sample adequacy evaluation: for example, the bioptome without the use of ionizing radiation [58,59] optimal, suboptimal. and may be useful in biopsy of cardiac masses. The principal complications of EMB include hematoma, These guidelines should be viewed as recommendations arteriovenous fistula, vasovagal reaction, pneumothorax, and not as mandatory requirements. They represent an overall consensus of the committee members and the opinions expressed are not necessarily those of all members Table 1 of the Association for European Cardiovascular Pathology Technical procedures for light microscopy examination and/or the Society for Cardiovascular Pathology. Routine procedure Fixation in buffered formalin for 15–30 min Processing in automatic processor overnight Rapid procedure for Microwave fixation 2. Recommendations, limits, and precautions transplant and urgent Processing in microwave or vacuum-prepared diagnostic biopsies automatic processor (maximum 30–40 min) The modern view of diagnostic EMB requires the Cutting (routine Serial and numbered sections of paraffin- and rapid) embedded biopsies using at least two thirds of pathologist to have specific professional training [27], use the samples accurate specimen processing [28], and support when Half the cut sections are stained with warranted the traditional histological examination with hematoxylin–eosin; the others are mounted on histochemical, immunohistochemical (IHC), molecular, or sialinized slides (or on slides with polylysine or ultrastructural tests (Tables 1 and 2) [24,29–45] and apply electrostatic charge) for possible further stains. O. Leone et al. / Cardiovascular Pathology 21 (2012) 245–274 247 Table 2 Stains on paraffin-embedded and frozen tissue Stains on formalin-fixed and paraffin-embedded sections Histomorphological and ▪ Masson or Mallory trichrome, Movat pentachrome, Weigert–Van Gieson for collagen and elastic fibers histochemical stains ▪ PAS with and without diastase for glycogen storage (better on frozen sections) ▪ Congo red, sulfate alcian blue, or S/T thioflavin for amyloid ▪ Perls' iron IHC stains ▪ CD45, CD20, CD3, CD4, CD8, CD68/PGM1, HLA-DR. HLA-ABC for inflammatory and cellular infiltrate assessment ▪ Transthyretin, kappa and lambda chains, apolipoprotein, amyloid A component for amyloid typing ▪ Appropriate antibodies for neoplasm characterization ▪ Dystrophin, lamin A/C a, desmin, a plakoglobin, a N-cadherin a for some genetic CMPs Stains on frozen sections Histomorphological and Sudan black, oil red 0, PAS with and without diastase histochemical stains Histoenzymatic stains SDH and COX Immunofluorescence stains Many immunostains listed above, including amyloid subtypes and desmosomal proteins, may be performed on frozen tissue. Frozen tissue may be better than immunohistochemistry for dystrophin (−COOH and NH2 ends, intermediate domain) and HLA-ABC. PAS = periodic acid-Schiff; SHD = succiante dehydrogenase; COX = cytochrome oxidase. a In the course of validation for diagnostic use. arrhythmia, heart block, infection, tricuspid valve damage, ■ brady- or major ventricular tachyarrhythmias to iden- pulmonary embolism or systemic embolism during left tify or exclude possible myocardial causes of arrhyth- ventricular biopsy, and cardiac chamber perforation with mias (e.g., myocarditis, ARVC, sarcoidosis, etc.), possible hemopericardium and cardiac tamponade [60,61]. ■ chronic heart failure to evaluate myocardial diseases In skilled hands, EMB is a safe procedure [55]. The with dilated–hypokinetic or hypertrophic–restrictive overall complication rate is low (1%–2%) [5]. In particular, phenotype, the risk of cardiac perforation was estimated at 0.4% in the ■ acute exacerbation of chronic CMP, largest case records in the world published in 1980 [62] and ■ investigation of cardiac masses, and at 0.12% in more recent data regarding a large number of ■ assessment of cardiac transplant biopsy specimens. patients (3048 cases) [63]. 5. Pathological
Load more

Recommended publications
  • Diagnosis and Treatment of Myocarditides
    DIAGNOSIS AND TREATMENT OF MYOCARDITIDES Clinical guidelines Task force for preparing the text of recommendations Chairperson: Professor S.N. Tereshchenko (Moscow), Task force members: I.V. Zhirov (MD, Moscow), Professor V.P. Masenko (MD, Moscow), O.Yu. Narusov (Ph.D., Moscow), S.N. Nasonova (Ph.D., Moscow), Professor A.N. Samko (MD, Moscow), O.V. Stukalova (Ph.D., Moscow) and M.A. Shariya (MD, Moscow) Expert Committee: Professor Arutyunov G.P. (Moscow), Professor Moiseev S.V. (Moscow), Professor Vasyuk Yu.A. (Moscow), Professor Garganeeva A.A. (Tomsk), Professor Glezer M.G. (Moscow region), Professor Tkacheva O.N. (Moscow) Professor Shevchenko A.O. (Moscow), Professor Govorin A.V. (Chita), Professor Azizov V.A. (Azerbaijan), Professor Mirrahimov E.M. (Kyrgyzstan), Professor Abdullaev T.A. (Uzbekistan), Ph.D. Panfale E.M. (Moldova), MD Sudzhaeva O.A. (Belarus) Moscow, 2019 TABLE OF CONTENTS Page INTRODUCTION ............................................................................................................. 4 Evidence Base for Diagnosis and Treatment of Myocarditides…………….……6 I. MYOCARDITIDES CLASSIFICATION ................................................................... 5 1. Fulminant myocarditis. .................................................................................................... 6 2. Acute myocarditis. ........................................................................................................... 6 3. Chronic active myocarditis. ............................................................................................
    [Show full text]
  • This Table Summarizes Changes to the HF Qxq As of 10/11/2019 Question
    Updated HFS Instructions (QxQs) This table summarizes changes to the HF QxQ as of 10/11/2019 Question in HF QxQ Description of Changes in HF QXQ General Instructions, pg. 3 Clarification added to rules for history Q29.d.10., pg. 40 Clarification made on how to record pulmonary hypertention Q29.d.14., pg. 41 Clarification made on how to record diastolic dysfunction Q42., pg. 42 Clarification made on how to record troponin I Section VII: Medication, pg. 54 Clarificaiton made on how to record medications Appendix A, pg. 61 Updated list of medications Edoxaban (ACOAG, Generic) Lixiana (ACOAG, Trade) Prexxartan (ARB, Trade) INSTRUCTIONS FOR COMPLETING HEART FAILURE HOSPITAL RECORD ABSTRACTION FORM HFS Version C, 10/1/2015 HFA Version D, 10/1/2015 HF QxQ, 10/11/2019 Table of Contents Page General Instructions……………………………………………………………….. 2 Specific Items………………………………………………………………………. 3 Section l: Screening for Decompensation………………………………….. 5 Section ll: History of Heart Failure…………………………………………... 10 Section lll: Medical History ………………………………………………….. 13 Section lV: Physical Exam - Vital Signs…………………………………….. 24 Section V: Physical Exam - Findings……………………………………….. 26 Section Vl: Diagnostic Tests…………………………………………………. 31 Section Vll: Biochemical Analyses………………………………………….. 48 Section Vlll: Interventions…………………………………………………….. 51 Section lX: Medications………………………………………………………. 54 Section X: Complications Following Events………………………………… 59 Section Xl: Administrative……………………………………………………. 60 Appendix A: ARIC Heart Failure/Cardiac Drugs: ………………………………. 61 Alphabetical Sort Appendix B: Potential Scenarios of the Onset of Heart………………………. 73 Failure Event or Decompensation HF QxQ 10/11/2019 Page 1 of 73 General Instructions The HFAA form was initially used for all discharges selected for HF surveillance. It was replaced by the HFAB and HFSA forms and then updated June 2012 with HFAC and HFSB.
    [Show full text]
  • The Meaning of Different Forms of Structural Myocardial Injury, Immune Response and Timing of Infarct Necrosis and Cardiac Repair
    CORE Metadata, citation and similar papers at core.ac.uk Provided by Archivio della ricerca- Università di Roma La Sapienza Send Orders for Reprints to [email protected] 6 Current Vascular Pharmacology, 2015, 13, 6-19 The Meaning of Different Forms of Structural Myocardial Injury, Immune Response and Timing of Infarct Necrosis and Cardiac Repair Emanuela Turillazzi1*, Cristoforo Pomara1, Stefania Bello1, Margherita Neri1, Irene Riezzo1 and Vittorio Fineschi2 1Institute of Legal Medicine, Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy; 2Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza Uni- versity of Rome, Rome, Italy Abstract: Although a decline in the all-cause and cardiac mortality rates following myocardial infarction (MI) during the past 3 decades has been reported, MI is a major cause of death and disability worldwide. From a pathological point of view MI consists in a particular myocardial cell death due to prolonged ischemia. After the onset of myocardial ischemia, cell death is not immediate, but takes a finite period of time to develop. Once complete myocytes’ necrosis has occurred, a process leading to a healed infarction takes place. In fact, MI is a dynamic proc- ess that begins with the transition from reversible to irreversible ischemic injury and culminates in the replacement of dead myocardium by a fibrous scar. The pathobiological mechanisms underlying this process are very complex, involving an in- flammatory response by several pathways, and pose a major challenge to ability to improve our knowledge. An improved un- derstanding of the pathobiology of cardiac repair after MI and further studies of its underlying mechanisms provide avenues for the development of future strategies directed toward the identification of novel therapies.
    [Show full text]
  • Viruses and Myocarditis NORMAN R
    Postgrad Med J: first published as 10.1136/pgmj.48.566.750 on 1 December 1972. Downloaded from Postgraduate Medical Journal (December 1972) 48, 750-753. Viruses and myocarditis NORMAN R. GRIST THE observations described here were made in the inoculated into newborn mice. Nevertheless, signi- course of the work ofthe Regional Virus Laboratory, cant differences have been observed between the Glasgow, which provides a widely-used diagnostic associations of different types of echovirus with service. Our investigations of cardiac cases have cardiac and Bornholm disease suggesting that some concentrated particularly on enteroviruses, the main (notably types 6 and 19) may occasionally mimic group of viruses associated with acute myocarditis. Coxsackie viruses by causing illnesses of this type Within this group the Coxsackie viruses have (Bell & Grist, 1970b). received particular attention, their well-known Some problems of virological interpretation are causal role in acute carditis and Bornholm disease illustrated by an adult male with acute pericarditis being possibly related to their characteristic proper- whose sera on the eighth and seventeenth days of ties of causing acute myositis in experimentally illness showed diagnostic rising antibody titres to infected newborn mice. Virological diagnoses were Coxsackie virus B types 1, 3, 4, and 6, high un- based on isolation of virus from faeces, and/or a changing titres to type B2, and a low rise (< 16 : 16) four-fold or greater rise in neutralizing antibody to type B5. These cross-reactions are fairly commonProtected by copyright. titres in paired sera (rarely a four-fold fall in titre and pose problems in specific interpretation; in this with acceptable time relationships) or an unusually particular case the infecting virus was demonstrated high antibody titre without significant fluctuation.
    [Show full text]
  • Diagnostic Yield and Safety Profile of Endomyocardial Biopsy in the Non
    REC Interv Cardiol. 2019;1(2):99-107 Original article Diagnostic yield and safety profile of endomyocardial biopsy in the non-transplant setting at a Spanish referral center Eusebio García-Izquierdo Jaén,a Juan Francisco Oteo Domínguez,a,* Marta Jiménez Blanco,a Cristina Aguilera Agudo,a Fernando Domínguez,a Jorge Toquero Ramos,a Javier Segovia Cubero,a Clara Salas Antón,b Arturo García-Touchard,a José Antonio Fernández-Díaz,a Rodrigo Estévez-Loureiro,a Francisco Javier Goicolea Ruigómez,a and Luis Alonso-Pulpóna a Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain b Servicio de Anatomía Patológica, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain ABSTRACT Introduction and objectives: Endomyocardial biopsy (EMB) is an established diagnostic tool in myocardial disease. However, this technique may carry major complications. We present the diagnostic and safety results of our experience in EMB in the non-trans- plant setting. We also present the results after the implementation of a technical and safety protocol developed at our center. Methods: We retrospectively analyzed the data of all EMBs conducted in non-transplant patients from September 2004 through July 2018. We compared the diagnostic yield and rate of major complications of EMB in two different periods: before and after implementing the protocol. Results: We included 204 EMBs performed in 190 patients. The most frequent indications were the evaluation of ventricular dys- function or suspected myocarditis (51.5%) and the evaluation of restrictive cardiomyopathy or suspected infiltrative disease (44.6%). One hundred and seventy-two EMBs were performed in the right cardiac chambers (84.3%) and 30 EMBs in the left cardiac chambers (14.7%).
    [Show full text]
  • Management of Chronic Problems
    MANAGEMENT OF CHRONIC PROBLEMS ALCOHOLIC MYOPATHY A. Chaudhuri* P.O. Behan† INTRODUCTION muscles. The clinical picture may be confused with venous Alcohol has been an integral part of man’s social history thrombophlebitis when muscle involvement is asymmetric5 since antiquity. After the art of distillation was rediscovered and, rarely, dysphagia can also occur. ARM may be associated in the Middle Ages, alchemists found, in ethanol, a cure for with signs of acute liver injury (acute alcoholic hepatitis) every illness, a tradition that still continues in this age with and congestive cardiac failure. Electromyography (EMG) the Gaelic name for whisky (usquebaugh, meaning ‘water of shows profuse fibrillations and myopathic changes similar life’). In more recent times researchers have wondered to acute polymyositis. Attacks of ARM may recur on a why the enzyme alcohol dehydrogenase, which converts number of occasions following alcoholic binges. ethanol to its major metabolite, acetaldehyde, exists in the Following its original description by Hed et al. in 1962,5 body if alcohol has no physiological role. acute alcoholic myopathy is now known to present with Though ‘alcohol’ is a generic name, in practice it usually variable severity, ranging from transient asymptomatic rises means ‘ethyl alcohol’ or ‘ethanol’ (C2H5OH). Other aliphatic in serum CK and myoglobin levels to a more fulminant alcohols include methyl alcohol (methanol) and isopropyl rhabdomyolysis, myoglobinuria and renal failure.6,7 It has alcohol, both of which are used as industrial solvents, are been recently suggested that magnetic resonance (MR) occasionally implicated in accidental human poisoning and imaging of thigh and leg muscles may be useful in the have no reported direct effect on skeletal muscles.
    [Show full text]
  • Treatment Options in Myocarditis and Inflammatory Cardiomyopathy
    Main topic Herz 2018 · 43:423–430 B. Maisch1 ·P.Alter2 https://doi.org/10.1007/s00059-018-4719-x 1 Fachbereich Medizin, Philipps-Universität Marburg und Herz- und Gefäßzentrum (HGZ) Marburg, Published online: 15 June 2018 Marburg, Germany © The Author(s) 2018 2 Klinik für Innere Medizin-Pneumologie und Intensivmedizin, UKGM und Philipps-Universität Marburg, Marburg, Germany Treatment options in myocarditis and inflammatory cardiomyopathy Focus on i. v. immunoglobulins In 2012 we reviewed the treatment op- proBNP) and high-sensitivity (hs) tro- curtain of diabetic cardiomyopathy, viral tions in (peri)myocarditis and inflamma- ponin T or I as cardiac biomarkers of heart disease with or without inflamma- tory cardiomyopathy in a special issue of heart failure and necrosis, respectively. tion can be hidden. But which of the this journal devoted to heart failure and Of note, cardiac MRI is an important factors is then the major etiological de- cardiomyopathies [1]. Now, 5 years later, method for clarifying the presence of terminant? itistimelyandappropriatetotakestock inflammation or fibrosis in addition to This issue also holds true for alcoholic of old and new data on this topic. function and pericardial effusion, but it cardiomyopathy [8]. In these patients, al- cannot substitute endomyocardial biopsy cohol consumption of more than 40 g/day Evolution of diagnoses for establishing an etiologically based di- in men and more than 20g/day in women agnosis [1–5]. For the diagnosis of viral formorethan5yearsisthesomewhat In 2013, experts of the European Soci- vs. autoreactive (nonviral) myocarditis arbitrary diagnostic determinant for the ety of Cardiology (ESC) working group and for the diagnosis of eosinophilic or label of alcoholic cardiomyopathy.
    [Show full text]
  • Childhood Acquired Heart Diseases in Jos, North Central Nigeria
    ORIGINAL ARTICLE Childhood acquired heart diseases in Jos, north central Nigeria Fidelia Bode-Thomas, Olukemi O. Ige, Christopher Yilgwan Department of Paediatrics, University of Jos, Jos, Nigeria ABSTRACT Background: The patterns of childhood acquired heart diseases (AHD) vary in different parts of the world and may evolve over time. We aimed to compare the pattern of childhood AHD in our institution to the historical and contemporary patterns in other parts of the country, and to highlight possible regional differences and changes in trend. Materials and Methods: Pediatric echocardiography records spanning a period of 10 years were reviewed. Echocardiography records of children with echocardiographic or irrefutable clinical diagnoses of AHD were identified and relevant data extracted from their records. Results: One hundred and seventy five children were diagnosed with AHD during the period, including seven that had coexisting congenital heart disease (CHD). They were aged 4 weeks to 18 years (mean 9.84±4.5 years) and comprised 80 (45.7%) males and 95 (54.3%) females. Rheumatic heart disease (RHD) was the cause of the AHD in 101 (58.0%) children, followed by dilated cardiomyopathy (33 cases, 18.9%) which was the most frequent AHD in younger (under 5 years) children. Other AHD encountered were cor pulmonale in 16 (9.1%), pericardial disease in 15 (8.6%), infective endocarditis in 8 (4.6%) and aortic aneurysms in 2 (1.1%) children. Only one case each of endomyocardial fibrosis (EMF) and Kawasaki Disease were seen during the period. Conclusions: The majority of childhood acquired heart diseases in our environment are still of infectious aeitology, with RHD remaining the most frequent, particularly in older children.
    [Show full text]
  • Intractable Chest Pain in Cardiomyopathy: Treatment by a Novel Technique of Cardiac Cryodenervation with Quantitative Immunohistochemical Assessment of Success
    574 Br HeartJ 1993;69:574-577 TECHNIQUE Br Heart J: first published as 10.1136/hrt.70.6.574 on 1 December 1993. Downloaded from Intractable chest pain in cardiomyopathy: treatment by a novel technique of cardiac cryodenervation with quantitative immunohistochemical assessment of success J AR Gaer, L Gordon, J Wharton, J M Polak, K M Taylor, W McKenna, D J Parker Abstract she described episodes of chest pain, usually A novel method of cardiac denervation on exertion but also at rest and at night. The by cryoablation has been developed ex- pain occurred up to 10 times daily and her perimentally. The technique uses liquid exercise tolerance had deteriorated from four nitrogen delivered under pressure to miles to 200 yards. Although she denied ablate the principal sources of cardiac paroxysmal nocturnal dyspnoea, she slept innervation-namely, the adventitia sur- with three pillows. Her medication at this rounding the aorta, pulmonary arteries, time consisted of sotalol (80 mg twice daily) and veins. The technique has been veri- and verapamil (240 mg twice daily). She had fied experimentally both in vivo by four children (aged 6, 8, 10, and 11 years) all physiological means and in vitro by of whom were healthy. She was unaware of a quantitative immunohistochemistry and family history of hypertrophic cardiomyopa- the measurement of myocardial nor- thy, although two members of her family had adrenaline concentrations. A 35 year old died suddenly in middle age. On admission a woman presented with intractable pre- soft pansystolic murmur and considerable cordial pain, normal epicardial coronary obesity were noted.
    [Show full text]
  • Infections and the Cardiovascular System New Perspectives Emerging Infectious Diseases of the 21St Century
    Infections and the Cardiovascular System New Perspectives Emerging Infectious Diseases of the 21st Century Series Editor: I. W. Fong Professor of Medicine, University of Toronto Head of Infectious Diseases, St. Michael’s Hospital INFECTIONS AND THE CARDIOVASCULAR SYSTEM: New Perspectives Edited by I. W. Fong Infections and the Cardiovascular System New Perspectives Edited by I. W. Fong Professor of Medicine, University of Toronto Head of Infectious Diseases, St. Michael's Hospital Toronto, Ontario, Canada KLUWER ACADEMIC PUBLISHERS NEW YORK, BOSTON, DORDRECHT, LONDON, MOSCOW eBook ISBN: 0-306-47926-5 Print ISBN: 0-306-47404-2 ©2004 Kluwer Academic Publishers New York, Boston, Dordrecht, London, Moscow Print ©2003 Kluwer Academic/Plenum Publishers New York All rights reserved No part of this eBook may be reproduced or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, without written consent from the Publisher Created in the United States of America Visit Kluwer Online at: http://kluweronline.com and Kluwer's eBookstore at: http://ebooks.kluweronline.com Preface Infectious agents have been recognized to involve the heart and vascular system for well over a century. Traditional concepts and teachings of their involvement in the pathogenesis of disease have been by a few established mechanisms. Bacterial and occasionally fungal microorganisms were known to invade and multiply on the endocardium of valves, vascular prostheses or shunts and aneurysm. Similarly viral, bacterial, mycobacterial, fungal, and parasitic pathogens could cause disease by invasion of the pericardium and muscles of the heart. Pathogenesis of some diseases of the endocardium, myocardium, and pericardium could involve indirect mechanisms with molecular mimicry inducing injury through an autoimmune process, such as in rheumatic heart disease and post viral cardiomyopathy.
    [Show full text]
  • Toxicological Profile for Hydrazines. US Department Of
    TOXICOLOGICAL PROFILE FOR HYDRAZINES U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Agency for Toxic Substances and Disease Registry September 1997 HYDRAZINES ii DISCLAIMER The use of company or product name(s) is for identification only and does not imply endorsement by the Agency for Toxic Substances and Disease Registry. HYDRAZINES iii UPDATE STATEMENT Toxicological profiles are revised and republished as necessary, but no less than once every three years. For information regarding the update status of previously released profiles, contact ATSDR at: Agency for Toxic Substances and Disease Registry Division of Toxicology/Toxicology Information Branch 1600 Clifton Road NE, E-29 Atlanta, Georgia 30333 HYDRAZINES vii CONTRIBUTORS CHEMICAL MANAGER(S)/AUTHOR(S): Gangadhar Choudhary, Ph.D. ATSDR, Division of Toxicology, Atlanta, GA Hugh IIansen, Ph.D. ATSDR, Division of Toxicology, Atlanta, GA Steve Donkin, Ph.D. Sciences International, Inc., Alexandria, VA Mr. Christopher Kirman Life Systems, Inc., Cleveland, OH THE PROFILE HAS UNDERGONE THE FOLLOWING ATSDR INTERNAL REVIEWS: 1 . Green Border Review. Green Border review assures the consistency with ATSDR policy. 2 . Health Effects Review. The Health Effects Review Committee examines the health effects chapter of each profile for consistency and accuracy in interpreting health effects and classifying end points. 3. Minimal Risk Level Review. The Minimal Risk Level Workgroup considers issues relevant to substance-specific minimal risk levels (MRLs), reviews the health effects database of each profile, and makes recommendations for derivation of MRLs. HYDRAZINES ix PEER REVIEW A peer review panel was assembled for hydrazines. The panel consisted of the following members: 1. Dr.
    [Show full text]
  • Currentstateofknowledgeonaetiol
    European Heart Journal (2013) 34, 2636–2648 ESC REPORT doi:10.1093/eurheartj/eht210 Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases Downloaded from Alida L. P. Caforio1†*, Sabine Pankuweit2†, Eloisa Arbustini3, Cristina Basso4, Juan Gimeno-Blanes5,StephanB.Felix6,MichaelFu7,TiinaHelio¨ 8, Stephane Heymans9, http://eurheartj.oxfordjournals.org/ Roland Jahns10,KarinKlingel11, Ales Linhart12, Bernhard Maisch2, William McKenna13, Jens Mogensen14, Yigal M. Pinto15,ArsenRistic16, Heinz-Peter Schultheiss17, Hubert Seggewiss18, Luigi Tavazzi19,GaetanoThiene4,AliYilmaz20, Philippe Charron21,andPerryM.Elliott13 1Division of Cardiology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padova, Italy; 2Universita¨tsklinikum Gießen und Marburg GmbH, Standort Marburg, Klinik fu¨r Kardiologie, Marburg, Germany; 3Academic Hospital IRCCS Foundation Policlinico, San Matteo, Pavia, Italy; 4Cardiovascular Pathology, Department of Cardiological Thoracic and Vascular Sciences, University of Padua, Padova, Italy; 5Servicio de Cardiologia, Hospital U. Virgen de Arrixaca Ctra. Murcia-Cartagena s/n, El Palmar, Spain; 6Medizinische Klinik B, University of Greifswald, Greifswald, Germany; 7Department of Medicine, Heart Failure Unit, Sahlgrenska Hospital, University of Go¨teborg, Go¨teborg, Sweden; 8Division of Cardiology, Helsinki University Central Hospital, Heart & Lung Centre,
    [Show full text]