Myocardial metabolism in toxin-induced heart failure and therapeutic implications
Abstract
Under normal conditions, myocardial metabolism is 60-80% reliant on the oxidation of fatty acids. This can be modified by conditions such as ischemia or poisoning with specific drugs, with the myocardium becoming more dependent on carbohydrate metabolism for energy. Acute poisoning with cardiotoxic drugs may be complicated by heart failure that is at present usually treated by inotropic drugs and vasopressors. However, changes in metabolic processes in poisoning may offer an opportunity for novel therapies. The scientific evidence obtained from ischemia-reperfusion models and the preservation of myocardial metabolism when myocardial blood flow is restored after a brief coronary occlusion (a theory known as "myocardial stunning") support this concept. Generalized or localized myocardial stunning may develop in patients who do not present with acute myocardial ischemia secondary to coronary artery disease, a condition referred to as takotsubo cardiomyopathy. This is characterized by the preservation of myocardial blood flow, associated with a depressed myocardial contractility, lasting from hours to weeks. Several factors have been associated with takotsubo cardiomyopathy:- excessive sympathetic stimulation, either from exogenous...Continue Reading
References
Assessment of hyperglycemia after calcium channel blocker overdoses involving diltiazem or verapamil
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