Myocardial metabolism in toxin-induced heart failure and therapeutic implications

Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists
Philippe Hantson, Christophe Beauloye

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

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Citations

Oct 2, 2013·Indian Journal of Critical Care Medicine : Peer-reviewed, Official Publication of Indian Society of Critical Care Medicine·Xavier Wittebole, Philippe Hantson
Dec 3, 2013·Journal of Pain and Symptom Management·Stephen B Singh, Ingrid A Harle
Jan 31, 2014·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·K T KopecJ B Leikin
Aug 9, 2012·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Yasmean Kalam, Andis Graudins
Jun 1, 2017·Current Opinion in Anaesthesiology·Lotte C G Hoegberg, Sophie Gosselin
Feb 27, 2019·Clinical Toxicology : the Official Journal of the American Academy of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists·Katherine G KatzungKristin M Engebretsen

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